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A 38-year-old man was referred to our retinal department following a diagnosis of central retinal vein occlusion (CRVO) in his right eye 3 days previously. His referring physician had started anti-aggregant therapy. Best-corrected visual acuity (BCVA) was 20/40. No afferent pupillary defect was detected. Slit lamp examination revealed a normal ocular anterior segment and clear media. The intraocular pressure was 15 mm Hg in both eyes. Funduscopic examination showed alterations consistent with the diagnosis of CRVO such as dilated and tortuous retinal veins and diffuse spotty and flame-shaped intraretinal haemorrhages. However, an unusual perivenular whitening was detectable at the posterior pole. This finding, associated with the scanty haemorrhage number and the absence of clinically visible macular oedema, prompted further analysis to rule out an arterial ischaemic event.
As a result of the multi-imaging approach, the typical fern-like perivenular changes that characterise impending CRVO became clearly detectable, allowing the clinicians to reach the correct diagnosis. In accordance with the literature, the patient did not receive any treatment and anti-aggregant therapy was suspended.1 Follow-up visits were scheduled and performed for 1 year. BCVA gradually improved from 20/63 …
Contributors AI: data collection, writing, final approval. MP: data collection, literature search. AG: writing, final approval. GS: critical revision, final approval.
Competing interests GS is a consultant for Heidelberg Engineering, which is the manufacturer of the instrument employed in this study.
Patient consent Obtained.
Ethics approval IRB—Medical Director of the Hospital.
Provenance and peer review Not commissioned; externally peer reviewed.