Case report

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 …