Central Retinal Vein Occlusion - Patchy Ischemic Retinal Whitening

These images come from a 28-year old woman with patchy ischemic retina whitening (PIRW), a variant presentation of acute, nonischemic central retinal vein occlusion (CRVO). It occurs typically in younger patients and is associated with generally good visual outcomes. She presented with a visual acuity of 20/20 in the left eye. The color fundus shows dilated, dark retinal veins with rare intraretinal hemorrhages (white arrows) and areas of ischemic whitening (yellow arrows) along a cilioretinal arteriole and in a perivenous location surrounding the macula. The red arrows on the OCT scans show areas of increased reflectivity within the inner nuclear layer spreading into the outer and inner plexiform layers, a finding known as paracentral acute middle maculopathy (PAMM). Additionally, the blue arrow highlights a hyporeflectivity in the retinal pigment epithelium layer underlying the area of PAMM.