History

67 year old male presents for initial examination. He reported seeing well although the left eye is a little blurry.

Medical History

• Hypertension
• Arthritis
• COPD

Examination

• Vision: 20/20 OD and 20/30- OS
• Pupils: Round and reactive without APD
• Motility: Full OU
• Intraocular pressures: Normal OU
• Slit lamp examination: noncontributory. There was early NSC OU
• Fundus Examination:
• OD: Hypertensive retinopathy
• OS: See photo

Ancillary tests

• Fluorescein Angiogram:

A - Color
A.		B.
C.		D.

Fluorescein Angiography

A large area of capillary drop out in the superotemporal retina with small tortuous vessels surrounding it. There is late staining of the vessels in this area. There is a neovascularization of the optic disc that leak dye in the late phases of the angiogram.

Diagnosis:

Branch Retinal Vein Occlusion (BRVO)

A common retinal vascular disease presenting most frequently in the 6th to 8th decades and affecting both sexes equally. It is thought to results from vein wall damage at the site of A/V crossing due to hypertensive and atherosclerotic changes which predisposes to clot formation. Risk factors include hypertension, cardiovascular disease, old age and glaucoma. Patients typically present with metamorphopsia, blurred vision and visual field loss in one eye. Retinal findings include venous dilation and tortuousity; retinal hemorrhages, cotton-wool spots and edema in the acute phase, and sheathing of the vessels along with fine tortuous vasculature and microaneurysms are seen in old cases.

Typical fluorescein angiogram findings include delayed venous filling and prolonged venous circulation time of the involved vein. microaneurysms, telengiectatic vessels and retinal edema are common. Capillary nonperfusion and enlarged foveal avascular zone (FAZ) can also be seen.

Patients with BVO are observed for 3 months after the initial insult for spontaneous improvement of macular edema. If the edema persists and the vision remains limited then focal laser photocoagulation was found to be helpful in the absence of macular ischemia of fluorescein angiography. If retinal neovascularization develops, scatter photocoagulation to the ischemic area reduces the risk of vitreous hemorrhage and prevents further vision loss. These guidelines were set forth by the branch vein occlusion study (BVOS).