Cilioretinal Artery Insufficiency in Central Retinal Vein Occlusion

Images from a 56 year old female with a nonischemic central retinal vein occlusion of the left eye with associated cilioretinal artery insufficiency. The visual acuity was 20/20 in the left eye and her complaint was of an inferiror paracentral scotoma on the left. A - Color fundus photograph of the left eye shows dilated retinal veins in all four quadrants with scant intraretinal hemorrhages in all quadrants and mild nasal rim optic disk edema. The perimacular retina supplied by a superotemporal ciliretinal artery is relatively opacified reflecting decreased blood flow and hypoxia (black oval circles the opacified area). B - Frame from the early venous phase of the fluorescein angiogram of the left eye. The purple arrow denotes the cilioretinal artery. The blue arrow denotes a branch retinal artery that supplies an adjacent area of the retina. Note that the origins of the branch retinal artery and the cilioretinal arteries are distinct. The yellow arrow denotes a second order cilioretinal arteriole that supplies the hypoxic, opacified retina. There is no infarction. The perfusion of capillaries is sustained. The hypoxia is functional, relating to an imbalance between the available blood flow and the high oxygen demands of the perimacular inner retina. C - Magnified view of the disk and superior macula. The cilioretinal artery is indicated by the black arrow. D - Magnified view of the disk and superior macula from the early venous phase fluorescein angiogram. The red arrow denotes the distinct origin of the cilioretinal artery compared to the adjacent branch retinal artery.