Branch Retinal Vein Occlusion

September 14, 2005
Leonid Skorin, Jr, DO

A dilated and tortuous vein, flame-shaped hemorrhages, dot-blot hemorrhages, and cotton-wool spots (retinal ischemia) that extended along the supranasal retinal arcade of the right eye were found during a 73-year-old man's annual eye examination. Because these changes were isolated to one quadrant and did not involve the macular area, the patient had no symptoms.

A dilated and tortuous vein, flame-shaped hemorrhages, dot-blot hemorrhages, and cotton-wool spots (retinal ischemia) that extended along the supranasal retinal arcade of the right eye (A) were found during a 73-year-old man's annual eye examination. Because these changes were isolated to one quadrant and did not involve the macular area, the patient had no symptoms.

Occlusion of a retinal venous branch typically occurs in the seventh decade of life and develops because the blood flow in the affected venous branch is slowed or interrupted.1 To rule out temporal arteritis and other systemic diseases in patients with a retinal venous obstruction who are older than 50, measure blood pressure, fasting blood glucose level, cholesterol and triglyceride levels, and erythrocyte sedimentation rate and obtain an ECG and a carotid duplex ultrasonogram. A more extensive evaluation for underlying vasculitides or coagulopathies is warranted for younger patients.

In the mid 1980s, the Branch Vein Occlusion Study (BVOS) recommended guidelines for the treatment of this condition.2,3 A fluorescein angiogram can be obtained as a baseline study to identify ischemia or neovascularization. If the macula is involved, postpone focal argon laser treatment for at least 3 months, because macular edema often clears spontaneously. Focal grid photocoagulation for chronic macular edema may be helpful in resolving persistent leakage. Panretinal photocoagulation is performed on patients who develop retinal or iris neovascularization. For the first 6 months post-treatment, monthly or bimonthly follow-up visits to an ophthalmologist are recommended; after the hemorrhages clear, an examination every 3 to 12 months should be scheduled.

Two months after the patient's initial presentation, a funduscopic examination found more extensive hemorrhaging as the condition evolved (B). His vision remained unaffected, and there was no evidence of macular involvement or neovascularization. Therefore, no treatment was initiated and close observation was continued.

REFERENCES:1. Fekrat S, Finkelstein D. Retinal vein occlusion. In: Mercado HQ, Alfaro DV, Liggett PE, et al, eds. Macular Surgery. Philadelphia: Lippincott Williams & Wilkins; 2000:132-146.
2. The Branch Vein Occlusion Study Group. Argon laser photocoagulation for macular edema in branch vein occlusion. Am J Ophthalmol. 1984;98:271-282.
3. The Branch Vein Occlusion Study Group. Argon laser scatter photocoagulation for prevention of neovascularization and vitreous hemorrhage in branch vein occlusion: a randomized clinical trial. Arch Ophthalmol. 1986;104:34-41.