This 60YO male presented with hand motion vision in his right eye from an inferior hemiretinal vein occlusion (HRVO).
Optos color imaging shows white and sheathed retinal vessels inferiorly and extensive temporal collateral vessels.
Fluorescein angiography confirms the marked clinical ischemia. There was no neovascularization. OCT scanning shows marked diffuse macular edema.
The patient refused anti-VEGF therapy, and actually got up and walked out of the exam room before we could finish our discussion regarding why treatment was needed!
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).
