Chronic Macular Branch Vein Occlusion with Subtle Ophthalmoscopic Signs

Images from a patient with a chronic macular branch retinal vein occlusion and macular edema. A - Color fundus photograph showing a single microaneurysm superonasal to the center of the macula (the black arrow). B - Frame from the mid-phase fluorescein angiogram of the left eye. More abnormalities are apparent than could be seen clinically or on the color fundus photograph. The microaneurysm is indicated by the yellow arrow. C - A magnified portion of the frame in B shows two microaneurysms (the yellow arrows) and an intraretinal collateral vessel (the green arrow). D - A spectral domain-OCT line scan showing a cyst (the yellow arrow) involving the center of the macula. When the hemorrhages of an acute macular branch retinal vein occlusion resolve, the residual signs can be subtle, as in this case. Rare microaneurysms may be seen. Macular edema may be detected by OCT, but not by clinical examination. It is common for there to be no leakage on fluorescein angiography yet to see macular edema on OCT