This 78YO male presented with counting finger vision in his right eye. He had a prior CRVO in his left eye, causing hand motion vision.
Optos color imaging shows mild to moderate bilateral scattered retinal hemorrhages. Fluorescein angiography shows fairly good perfusion with leaking vessels OD with severe diffuse ischemia OS.
Swept-source OCT shows severe central macular edema OD with an atrophic left macula.
Anti-VEGF therapy was started for the edema OD.
Learning Points:
Prior to the introduction of intravitreal injections in the early 2000s, there were essentially no treatments for CRVO-related macular edema.
Anti-VEGF injections in general are now the initial treatment of choice, with about 50-60% of eyes gaining at least 3 lines of vision. Intravitreal steroids, usually Ozurdex, are more often used as secondary treatment.
Macular grid laser photocoagulation is not performed since it was shown to have no visual benefit in the Central Vein Occlusion Study Group (see Ophthalmology 1995;102;1425-1433).
