Central Retinal Vein Occlusion in a Patient with Open Angle Glaucoma

Example of central retinal vein occlusion developing in the context of open angle glaucoma. An 82 year- old man treated for open angle glaucoma noted loss of vision in his left eye two weeks before presenting for examination. His best corrected visual acuity was 20/40 in the left eye. A - A pattern of intraretinal hemorrhages throughout the posterior pole is shown without venous dilation. The image suggests a central retinal vein occlusion that is much older than the two weeks of noted symptoms inasmuch as there is little venous distention and relatively few hemorrhages. The yellow arrows indicated intraretinal hemorrhages and the green arrow a spared central macular zone. These should be compared to the OCT image in E. B - Magnified optic disk photograph showing advanced glaucomatous optic atrophy with neural rim thinning inferiorly (the yellow arrow). C - Frame from the mid-phase fluorescein angiogram showing good perfusion of the retinal capillaries. This is a nonischemic central retinal vein occlusion. D - Frame from the late phase fluorescein angiogram showing leakage of fluorescein dye from the paramacular capillaries. E - Horizontal OCT line scan shows marked macular thickening. The yellow areas correspond to areas of intraretinal hemorrhage. These hemorrhages block imaging of the inner segment/ outer segment junction and the retinal pigment epithelium (the yellow arrows). The clear central macular zone (compare to A) is occupied by a large cyst (the green arrow). The retinal pigment epithelium is well imaged, but the inner segment/ outer segment junction is not seen.