Hemicentral retinal vein occlusion - conversion from nonischemic to ischemic form

Fundus images of a 66 year old woman with hypertension and diabetes. Her initial presentation was captured in A and C; one month later her appearance was captured in B and D. A - At presentation, there is ischemic retinal whitening in the superior hemimacula. The OCT (inset) shows a parafoveal cyst in the outer nuclear layer. B - Color fundus image and OCT one month after presentation. There is more intraretinal hemorrhage, a common sign of an increasingly ischemic hemi CRVO. The OCT (inset) shows much more outer retinal edema, some subretinal fluid, and some thinning of the inner retinal layers with loss of definition suggesting atrophy secondary to the ischemia. C - Frame from the midphase fluorescein angiogram at presentation shows delayed venous filling superiorly. Capillary detail is preserved in most of the involved retina. D - Frame from the midphase fluorescein angiogram at the one month follow-up visit shows loss of capillary detail in most of the involved retina. The previously nonischemic hemi-CRVO has converted to an ischemic form.