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Case 5-10. Central Retinal Vein Occlusion

Clinical Summary

A 74-year-old woman with a history of a macular hole in her left eye noticed a sudden decrease in vision in this eye two months earlier. Her systemic work-up was significant for hypertension, transient ischemic attacks, peripheral vascular disease, and atrial fibrillation. On examination, her visual acuity was counting fingers at six inches. Slit-lamp biomicroscopy (A) showed mild edema of the optic disc, dilated and tortuous retinal veins, diffuse macular edema, and significant retinal hemorrhages throughout the macula and periphery consistent with an occlusion of the central retinal vein. No neovascularization was reported. Fluorescein angiography (B) indicated delayed venous filling, diffuse hyperfluorescence of the disc and macula with late leakage consistent with papillary and macular edema, and widespread hypofluorescence due to retinal hemorrhage. The right eye, with a visual acuity of 20/25, was normal on fundus examination except for a posterior vitreous detachment.

Optical Coherence Tomography

OCT examination (D) of the left eye showed a profusion of the disk contour consistent with papilledema. Mild retinal thickening was noted, and was more significant in the nasal compared to the temporal macula. An elevation of the neurosensory retina above an optically lucent space was also observed consistent with a sensory retinal detachment. The right eye (E) was notable for a pseudo-operculum situated approximately 350 ¬°urn anterior to the fovea, suggesting an arrested stage of macular hole development in this eye-

Follow-up Examination

Three months later, the patient developed rubeosis iridis, and received panretinal photocoagulation treatment in her left eye with a dye yellow laser. A follow-up examination one month after the procedure showed regressed neovascularization of the iris and significantly reduced retinal hemorrhage (C), The optic disc remained elevated and mild to moderate retinal thickening was still present in the macula. Visual acuity was still counting fingers.

Fotlow-up Optical Coherence Tomography

A repeat horizontal OCT scan (F) demonstrated a resolution of the sensory retinal detachment observed earlier. The disc edema also was reduced. However, diffuse retinal thickening corresponding to macular edema was still observed, especially nasal to the fovea, and appeared to be slightly increased compared to the previous examination.

Retinal Vascular Occlusion

Temporal

250 \im

Log Reflection

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