This patient presented with counting-finger vision from an acute hemorrhagic central retinal vein occlusion (CRVO) with marked macular edema. The poor vision and extensive retinal hemorrhages suggest that this is an ischemic CRVO.
After five monthly anti-VEGF injections, vision improved to 20/50, the retinal hemorrhages resolved dramatically, optic disc collaterals formed, and OCT showed complete resolution of all macular fluid. This degree of improvement is quite unusual.
Learning Points:
Patients with CRVO are at risk of vision loss due to macular edema or anterior segment neovascularization. Macular edema is common in both non-ischemic and ischemic occlusions, and this responds best to anti-VEGF therapy.
Rubeosis is found almost exclusively with ischemic occlusions, developing in about two-thirds of patients with untreated ischemic occlusions. This was common in the pre-anti-VEGF days.
However, since most patients with CRVO have macular edema and are receiving ongoing anti-VEGF therapy, neovascularization is now rarely seen unless patients present with untreated CRVO or therapy is discontinued.
