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BRANCH RETINAL VEIN OCCLUSION SECONDARY TO A RETINAL ARTERIOLAR MACROANEURYSM

A NOVEL MECHANISM SUPPORTED BY MULTIMODAL IMAGING

Chen, Yi, MMed*,†; Chen, Simon D. M., MBBS, BSc (Hons), FRANZCO; Chen, Fred K., MBBS (Hons), PhD, FRANZCO*,†

Retinal Cases and Brief Reports: January 2019 - Volume 13 - Issue 1 - p 10–14
doi: 10.1097/ICB.0000000000000517
Case Report
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Background/Purpose: To report a case of a branch retinal vein occlusion secondary to a retinal arteriolar macroaneurysm (RAM).

Methods: Retrospective case report describing examination findings, treatment outcome and unique multimodal imaging features demonstrated on fluorescein angiography, optical coherence tomography, optical coherence tomography angiography and adaptive optics photography of the retinal vessels and RAM.

Results: A 61-year-old man presented with 20/200 vision in the right eye because of a branch retinal vein occlusion secondary to a RAM. After sector panretinal photocoagulation and a course of 24 intravitreal antivascular endothelial growth factor injections over 4 years, visual acuity improved to 20/25. Fluorescein angiography showed filling of the RAM even after 4 years. Optical coherence tomography angiography demonstrated venous collateral vessels in both the superficial and deep capillary plexuses, and adaptive optics imaging revealed a gap between the RAM wall and occluded vein.

Conclusion: Multimodal imaging of this unusual presentation illustrated a novel mechanism of branch retinal vein occlusion in which a primary RAM adjacent to the junction of two retinal veins led to obstruction of venous flow without evidence of direct compression. This supports the theory that perianeurysmal microenvironment changes may be of importance in the pathogenesis of venous occlusion.

The authors report the clinical features of a 61-year-old patient with a branch retinal vein occlusion caused by a retinal arteriolar macroaneurysm. The absence of direct contact between the macroaneurysm and the occluded retinal vein demonstrated on optical coherence tomography angiography and adaptive optics retinal imaging suggests that perivascular factors may mediate venous occlusion.

*Centre for Ophthalmology and Visual Science (incorporating Lions Eye Institute), The University of Western Australia, Perth, Western Australia, Australia;

Department of Ophthalmology, Royal Perth Hospital, Perth, Western Australia, Australia; and

Vision Eye Institute, Chatswood, New South Wales, Australia.

Reprint requests: Fred K. Chen, MBBS (Hons), PhD, FRANZCO, Centre for Ophthalmology and Visual Science (incorporating Lions Eye Institute), The University of Western Australia, 2 Verdun Street, Nedlands, WA 6009; e-mail: fredchen@lei.org.au

F. K. Chen received funding from NH&MRC Early Career Fellowship (APP1054712). Y. Chen is supported by the Miocevich Fellowship.

None of the authors has any conflicting interests to disclose.

© 2019 by Ophthalmic Communications Society, Inc.