This patient had prior intravitreal Avastin for macular edema from a hemiretinal vein occlusion (HRVO). When he developed recurrent edema with 20/60 vision, he wanted to try macular laser instead of more injections.
Preoperative angiography shows a slightly enlarged foveal avascular zone with diffuse inferior macular leakage. There is some peripheral retinal ischemia but no neovascularization.
Several months following grid laser, vision improved to 20/40 and angiography shows absence of macular leakage. Prominent collateral vessels are seen on the optic nerve inferiorly, in the temporal macula and nasal to the nerve.
En Face OCT of the outer retina and RPE dramatically shows the grid laser scars.
Learning Points:
Although intravitreal injections are the treatment of choice for macular edema in branch and hemiretinal vein occlusions, grid laser photocoagulation can still be helpful for patients who refuse injections or perhaps to decrease the treatment burden.
