Case Studies: Left Branch Retinal Vein Occlusion

A 40 year old patient presented with sudden onset of painless vision loss from his left eye. There were no associated ocular symptoms and he was systemically well, though moderately over weight.

On examination his corrected  acuities were right 6/6 and left 6/90. His intraocular pressures were normal. His anterior segments were unremarkable with clear ocular media and no rubeosis. Dilated fundus examination on the right was essentially unremarkable and on the left there were  retinal haemorrhages and cotton-wool spots, along the superotemporal arcade, consistent with a branch retinal vein occlusion. On OCT scanning, he had significant associated macular oedema (see figure 1).

FIG 1

The patient was diagnosed with a left branch retinal vein occlusion. The most common cause underlying  cause is atherosclerotic disease, associated with systemic hypertension. However, given this patient was only 40 years of age, obstructive sleep apnoea and pro-coagulant diseases need to be ruled out.

Treatment of intravitreal Lucentis injection therapy was instituted, and four weeks after the first injection his vision returned to 6/9 and his macular oedema dramatically improved, as seen in figure 2 below.

FIG 2

A 61 year old female presents for a review of drusen in her right eye.

With glasses her visual acuity is right 6/12 improving to 6/7.5 with a pinhole, and left 6/9, improving to 6/7.5. Her intraocular pressures were 14mmHg bilaterally. Retinal examination revealed no drusen however we found Synchysis Scintillans in her right eye.

Synchysis scintillans is a vitreous disorder that is usually compared with asteroid bodies in the vitreous. These are extremely rare cholesterol crystals that move around freely in the vitreous and falls to the floor of the vitreous due to gravity. No treatment is required.

This is an OCT of a 59 year old female who presented with slow deterioration of central vision. This OCT shows a full thickness macula hole.

This is a classic Cavernous Haemangioma with a great white cluster of aneurisms and on the fluorescein angiography showing classic fluid levels.

This is a photo of a lady I saw yesterday. She is 82 years old and suffers from emphysema. Despite this, she still smokes. She has had cataract surgery in the past and presented with a four day history of decreased left vision.

On examination, her visual acuity was Right 6/12 and left Count fingers only.

As you can see, she has atrophic changes at her right macula and a huge left macular hemorrhage. I made a diagnosis of wet AMS and injected Lucentis intravitrally.

I asked her to use Macuvision tablets and stressed that she must stop smoking. Let’s see how she goes, I’ll keep you updated.

This is a classic Cavernous Haemangioma with a great white cluster of aneurisms and on the fluorescein angiography showing classic fluid levels.