Nonischemic Central Retinal Vein Occlusion with a Secondary Branch Retinal Artery Occlusion

A 78 year old woman with hypertension and a history of previous coronary artery disease and stroke developed a sudden scotoma of the left eye. She was found to have a nonischemic central retinal vein occlusion (CRVO) with a concomitant branch retinal artery occlusion. The VA was 20/20. During follow-up of 17 months, the CRVO resolved, but the scotoma from the branch retinal artery occlusion remained. VA has remained 20/20 in this eye.A - Monochromatic fundus photograph showing intraretinal hemorrhages in all quadrants as well as dilated veins. A region of ischemic retinal whitening is present around a branch retinal arteriole (the green arrow). B - Frame from the early-phase FA showing that the arteriole is a branch retinal arteriole and not a cilioretinal arteriole. It connects to a larger branch retinal artery (follow the green arrows). C - Frame from the arteriovenous-phase FA. D - Two 24-2 visual fields are shown. The first was obtained on 4/12/2006 and shows a suggestion of a superior Bjerrum scotoma. The second one was obtained on 7-26-2010 at the time of the fundus photographs. A new scotoma that corresponds to the location of the ischemic retinal whitening is present (the red oval). Cilioretinal arteriolar occlusion in association with CRVO has been described often, but branch retinal arteriolar occlusion in association with CRVO is much rarer. The cilioretinal arteriole derives from the choroidal circulation, which has a slightly lower arterial pressure than that of the central retinal artery, from which the branch retinal arteries derive. This accounts for the difference in frequency of these two events.