Bilateral Retinal Venous Anomaly in a Pathologic Myopia Patient

This 40 year old male presented for evaluation of myopic degeneration in both eyes. Upon examination, the diagnosis of pathologic myopia was confirmed, but also found were abnormal patterns of retinal venous drainage in both eyes. The green arrows in both frames indicate the central retinal artery, which brings blood into the retina through the nerve. The yellow circle in the right eye frame shows an optic pit-like abnormality. The inferior hemi-central retinal vein drains into this pit-like structure, which is abnormal. The purple arrow shows the looping of the superior hemi-central retinal vein, which drains to a peripapillary vein emptying into a choroidal vein. The left eye frame shows both the superior and inferior hemi-central retinal veins draining outside of the optic nerve margins (blue circles), draining into the choroidal veins that circle the optic nerve (black arrows, ring of Zinn). In the normal case, the two veins drain centrally in the optic nerve (see normal anatomy photo). The cause of this bilateral optic nerve abnormality is not known.