This 53YO male presented with a major superotemporal branch retinal vein occlusion (BRVO) and 20/40 vision.
Despite the deceptively good vision, Optos ultra-widefield imaging shows marked ischemia throughout the distribution of the occlusion, which fortunately spares the central macula. There is a broad zone of mostly fibrosed retinal neovascularization at the border of the occlusion superiorly.
Angiography demonstrates ischemia and leakage corresponding to the fibrosed retinal neovascularization.
Scatter laser throughout the area of ischemia was recommended.
Learning Points:
In 1986, the Branch Vein Occlusion Study Group reported that scatter laser decreased the risk of vitreous hemorrhage from retinal neovascularization in BRVO, and suggested that laser should be applied once neovascularization develops (Arch Ophthalmol 1986;104:34-41).
Thirty-five years later, scatter laser remains the gold standard, although some may prefer to stabilize neovascularization with anti-VEGF therapy before laser.
