This 82YO female presented with a major superotemporal branch retinal vein occlusion (BRVO) and hand motion vision. She reported decreased vision for over a year.
Optos photography shows a major superotemporal BRVO. A plaque of subretinal lipid is seen in the inferotemporal macula. Swept-source OCT through this lipid shows an unusual laminated, subretinal, hyperreflective mound. Fluorescein angiography shows some macular leakage and some areas of more peripheral ischemia.
Although the patient has a poor prognosis due to the chronicity of the disease, monthly intravitreal Avastin for the central edema was initiated in hopes that it may improve her vision.
Learning Points:
Lipid exudates are rarely seen in BRVO, which may be due to a physiologic defect in the inner blood-retinal barrier (the endothelial cell tight junctions) that are too small to allow larger lipoproteins to escape into the extracellular space.
When present, lipid is often associated with a retinal venous macroaneurysm (Cousins et al, AJO 1990;109:567-170), which was not visualized in our patient.
