By: Antonio Chirumbolo; OptometryStudents.com Content Coordinator, SUNY 2013
Retinal vein occlusion is the second most prevalent retinal vascular disease, only second to diabetes. Branch Retinal vein occlusions are three to four times more prevalent than central retinal vein occlusions. There is a strong association of RVO with systemic disease and several risk factors include HTN, DM, and even OAG. Generally, people over the age of 50 suffer from RVO.
Branch retinal vein occlusions involve various characteristics including: intraretinal hemorrhage following the course of the occluded vessels, macular edema, exudative reactions, and eventually collateralization and or neovascularization of the disk or elsewhere in the retina.
The course of BRVOs include various phases. In the latter phases, there generally is collateralization crossing the horizontal raphe in an attempt illicit drainage.
It can be very difficult at times to differentiate between collateralization and neovascularization. An important test that can be utilized in the detection of neovascularization is fluorescein angiography, which will show leakage and abnormal vasculature.
The Case:
A 61 yo WF presents for a FA (fluorescein angiography) to differentiate between parafoveal neovascularization versus collateralization with potential macular edema.
Patient was diagnosed with a BRVO in July 2011. A follow up appointment in September revealed an increase in ischemic signs and symptoms including cotton wool spots, additional mid-peripheral hemes, and telangiectasia.
The patient has a positive history of hypertensive retinopathy x 10 years.
VA/Externals:
VA: 20/20 -2 OD+OS
EOMs: Full 4 OU
PERRL (-)APD
Clinical Exam
Gonioscopy was open to CB all quadrants OU. (-)NVA, NVI
DFE revealed new superior temporal dot hemes, possible collateralization or neovascularization.
Fluorescein Angiography
Occluded vein seen superiorly.
Looking more closely at the potential neovascularization or collateralization:
Assessment and Plan
1. BRVO OS
– FA suggests collateral formation as opposed to neovascularization.
– VA stable at 20/20 OD+OS
– Gonioscopy reveals (-) NVI, NVA
– Ed pt on importance of HTN control and compliance c medications
– RTC 1 month for follow up.
Clinical Case by: Antonio Chirumbolo SUNY 2013
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