This 81YO female presented with 20/60 vision from a symptomatic superior hemiretinal vein occlusion (HRVO). Optos imaging shows foveal and superior inner retinal hemorrhages with a swollen optic nerve, and fluorescein angiography shows a well-perfused occlusion.
Swept-source OCT confirms moderate cystic macular edema with a trace amount of underlying subretinal fluid.
Age-related peripheral reticular degeneration of the RPE is best seen angiographically as an incidental finding.
The patient is receiving ongoing anti-VEGF injections to control her macular edema. Intravitreal injections (anti-VEGF or steroids) are the treatment of choice, although grid laser may help decrease the treatment burden.
Learning Points:
Branch retinal vein occlusions are virtually always caused by a retinal artery compressing a retinal vein within its common adventitial sheath.
Some people are born with an anomalous two-trunked central retinal vein that independently drains the superior and inferior retinal hemispheres.
HRVO, similar to central retinal vein occlusion, is caused by compression of the retinal vein posterior to the lamina cribrosa (see Hayreh, Arch Ophthalmol 1980;98:1600-1609).
