This 79YO female presented with acute inferior paracentral vision loss in her right eye. Vision was 20/50.
A large blister of dark subretinal blood was noted just inferior to the optic nerve. A few small areas of more distal red subretinal blood were seen. An inferior macular branch retinal artery occlusion likely accounted for her symptoms. The blood column is stagnant within the inferior portion of the acute occlusion.
OCT scanning through the BRAO shows hyperreflective inner retina with subretinal fluid.
Fluorescein angiography shows blockage from the subretinal blood, along with a leaking retinal arterial macroaneurysm (RAM).
Learning Points:
A BRAO can be a rare complication from direct thermal laser of a RAM (Russell and Folk, AJO 1987;104:186-187), which is one reason why this is almost never performed anymore. In this case, we believe the BRAO was secondary to mechanical arterial compression from the surrounding blood.
