Fluorescein Angiography Detection of Combined Branch Retinal Vein and Artery Occlusion.

Abstract

A77-year-old male with a history of diabetes mellitus, hypertension, chronic kidney disease, and hyperlipidemia presented for 1-month postoperative care following cataract extraction with a subjective complaint of a dark area in his left eye superior field. His uncorrected visual acuity measured 20/25 in each eye. The posterior ophthalmoscopic examination of the left eye revealed a large calcific embolus in the inferior retinal artery exiting the optic nerve (Fig. 1). The presence of moderate retinal hemorrhages consistent with diabetic and hypertensive retinopathy was evident.Figure 1: Color photograph showing large calcific embolus of the inferior retinal artery exiting the optic nerve.The fluorescein angiography study showed delayed filling of the inferior retinal artery in the arterial phase due to obstruction from an embolic vaso-occlusive event. The patient reported branch retinal artery occlusion symptoms, yet there were no acute ophthalmoscopic signs of venous occlusion. The collateral vein occlusion resulted from the proximity ofmechanical compression at the point of the shared arterial-venous adventitial sheath by the large embolus1 and was evident from the absent fluorescein filling within the inferior venous tributary (Fig. 2). Fluorescein angiography was of great diagnostic value to detect retinal non-perfusion from the combined branch retinal artery and vein occlusions, since the latter may have otherwise gone undiagnosed.Figure 2: Fluorescein angiography showing impaired inferior arterial filling and absent intermediate phase inferior venous circulation from embolic compression.