This 51YO male presented with 20/200 vision from an acute central retinal vein occlusion (CRVO).
There are virtually no posterior pole hemorrhages. Ultrawidefield Optos fluorescein angiography shows good posterior pole perfusion, although peripheral temporal ischemia is noted. Angiographic cystoid leakage is seen.
Triton swept-source OCT confirmed cystoid edema with some subfoveal fluid. Intravitreal anti-VEGF injections were started.
Learning Points:
The Central Vein Occlusion Study (CVOS) defined ischemic CRVO as having at least 10 disc areas of angiographic retinal nonperfusion as determined by standard photographic views with the Canon (60 degrees) or Topcon (45 degrees) wide-angle fundus camera (Ophthalmology 1995;102:1434-1444).
Although clearly ischemic, our patient would have been classified by the CVOS as a perfused occlusion.
As with diabetic retinopathy (see Brucker, Retina 2021;41:461-463), ultrawidefield imaging and anti-VEGF injections have thrown a literal wrench into how we think about, classify, and treat retinal disorders.
