Case of the Month | January 2021

Case of the Month
January 25, 2021

The Case

The patient was a 64-year-old woman who complained of new floaters and flashes in the right eye. Her visual acuity was 20/25-2 OD and 20/25-1 OS. Anterior segment examination was remarkable for early cataracts in each eye. Posterior segment examination of the right eye revealed a posterior vitreous separation and mild posterior vitreous hemorrhage. Careful peripheral examination did not reveal any retinal breaks. Both the right and left fundus had drusen. The left fundus also had temporal intraretinal dot hemorrhages without edema. The periphery of the left eye was unremarkable. What is the most likely cause of the dot hemorrhages in the left eye? What treatment, if any, would you recommend?

The fluorescein angiogram montage reveals that this patient had a macular branch retinal vein occlusion. There is dilation of blood vessels superotemporal to the fovea with fluorescein leakage. Note that the leakage respects the horizontal meridian, which is typical of BRVOs temporal to the disc. The shunt vessels that are typically seen in compensated BRVOs can be subtle in macular BRVOs. Without significant edema, we chose to monitor this patient. Some patients experience late edema accumulation.

This case illustrates the value of fluorescein angiography in diagnosing BRVO. While OCTA can also assist the diagnosis, the leakage pattern seen on fluorescein angiography can be very helpful. Fluorescein angiography can assist identifying BRVOs in patients who also have diabetic retinopathy.

Case Photos

Click the Images below to enlarge

The fluorescein angiogram montage reveals that this patient had a macular branch retinal vein occlusion. There is dilation of blood vessels superotemporal to the fovea with fluorescein leakage. Note that the leakage respects the horizontal meridian, which is typical of BRVOs temporal to the disc. The shunt vessels that are typically seen in compensated BRVOs can be subtle in macular BRVOs. Without significant edema, we chose to monitor this patient. Some patients experience late edema accumulation.

This case illustrates the value of fluorescein angiography in diagnosing BRVO. While OCTA can also assist the diagnosis, the leakage pattern seen on fluorescein angiography can be very helpful. Fluorescein angiography can assist identifying BRVOs in patients who also have diabetic retinopathy.

Download PDF Version
Return to News & Events