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Ophthalmic Images

Central retinal vein occlusion and branch retinal vein occlusion in the same eye

Sundar, M Dheepak; Puri, Prabhav; Chawla, Rohan; Hasan, Nasiq

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Indian Journal of Ophthalmology: August 2019 - Volume 67 - Issue 8 - p 1344
doi: 10.4103/ijo.IJO_168_19
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A 55-year-old hypertensive male, who had previously been diagnosed to have right eye inferio-temporal (IT) branched retinal vein occlusion (BRVO) 3 years ago and received treatment for the same, presented with sudden loss of vision in the same eye. Diffuse multiple flame-shaped hemorrhages along with tortuous vessels were noted in all three quadrants except the IT quadrant which had sclerosed vessels. The patient was diagnosed to have a fresh episode of central retinal vein occlusion (CRVO) in the same eye sparing the area of BRVO.

The fundus image [Fig. 1] illustrates a rare presentation of CRVO and BRVO in the same eye. Hayreh et al. propose that around 2.5% have chances of developing recurrent RVO (CRVO or BRVO) in the same affected eye.[1] A vigilant follow up is necessary for all the RVO patients as they are prone to second attack.

Figure 1
Figure 1:
(a) Fundus montage image of central retinal vein occlusion (CRVO) sparing the inferio-temporal area which has major branched retinal vein occlusion (BRVO). (b) Fundus fluorescein angiography of the same eye showing both the dilated leaky vessels (due to CRVO) and the attenuated vessels with collaterals (due to BRVO). (c and d) Optical coherence tomography displaying features of thinned out retina with cystoid degeneration (due to BRVO) and increased inner retinal layer reflectivity (due to fresh CRVO) in the same image

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1. Hayreh SS, Zimmerman MB, Podhajsky P. Incidence of various types of retinal vein occlusion and their recurrence and demographic characteristics Am J Ophthalmol. 1994;117:429–41
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