Branch Retinal Vein Occlusion - Asymptomatic

Clinical images from the case of an asymptomatic 68 year old female glaucoma suspect with treated hypertension and hypercholesterolemia. Her visual acuity was correctable to 20/20 bilaterally. She was found on a routine annual examination to have microvascular abnormalities in the left superotemporal macula. A - Monochromatic fundus photograph of the left eye shows the occluded branch vein with an smaller diameter proximal segment (red arrow) and a distended distal segment (green arrow). Tortuous collateral venules (yellow arrows) drain the venous return around the blocked site to adjacent venous beds. A region of relatively featureless retina is typical of an ischemic zone (blue oval, compare to B). B - A frame from the mid phase of the fluorescein angiogram shows a large microaneurysm (turquoise arrow) and the nonperfused region (blue oval, compare to A). C - Frame from the late phase of the fluorescein angiogram shows late fluorescein leakage in the distribution of the occluded vein. The fovea is uninvolved. D - Optical coherence tomography images of the left macula. The false color map shows retinal thickening superiorly (black arrow) and the line scan shows cystic change in the outer nuclear layer of the perifovea with preservation of the foveal depression.