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Central Carolina Surgical Eye Associates, P.A.
Case Four:
Hemiretinal vein occlusion

Color fundus photo showing an inferior hemi-retinal vein occlusion with cotton-wool spots and intraretinal hemorrhage.
Digital red free fundus photo demonstrates shunt vessel formation at the nasal margin of the optic disc. There are retinal folds in the macula and a central cyst like lesion.

Enlargement of digital red free photo reveals a macular cyst like lesion with retinal folds in the macula.
Early phase digital fluorescein angiogram reveals blocked fluorescence by hemorrhage and early capillary leakage in the macular region
Late phase digital fluorescein angiogram reveals diffuse leakage in the macula without apparent leakage or pooling in the cyst like lesion. Diffuse leakage is apparent from the inferiorly affected vessels

Comments

Hemiretinal vein occlusion. Retinal vein occlusion may involve half of the fundus and may be caused by obstruction of one of the dual trunks of the central retinal vein, an anomaly that occurs in approximately 20 % of individuals. The obstruction probably occurs at the level of the lamina cribrosa and pathogenetically is more closely related to central rather than branch retinal vein occlusion.( from Gass, J.D.M.: Stereoscopic atlas of macular diseases: diagnosis and treatment,ed.3, page 434, reprinted with permission .)

This  42 year old white male was referred for evaluation and treatment of decreased vision OS of 6 weeks duration. Dilated fundus exam revealed a blood and thunder appearance to the inferior half of the retina. Fluorescein angiography was performed and hemiretinal vein occlusion was confirmed. The patient is being followed for possible development of neovascularization and vitreous hemorrhage. Laser treatment is not recommended at this time.

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