Title
HEMI-RETINAL VEIN OCCLUSION: A CASE REPORT.
Introduction
Retinal vein occlusions are divided according to the location of the occlusive event. They can be classified as branch retinal vein occlusion, hemi-retinal vein occlusion (HRVO) and central retinal vein occlusion (CRVO). Visual loss is usually due to macular edema and retinal ischemia. Risk factors include diabetes mellitus, hypertension, hyperlipidemia, glaucoma and smoking. It is known that HRVO is clinically related to CRVO. The underlying pathophysiology is a congenital anatomic variation: a two-trunked central retinal vein in the anterior part of the optic nerve. As in the CRVO, an occlusion of one of these trunks can occur, causing a HRVO.
Methods
Medical record review.
Results
A 65-year-old man presented with sudden painless vision loss in his right eye. The best corrected visual acuity was 20/200 in the right eye and 20/20 in the left eye. He had a history of arterial hypertension and had been a smoker for 40 years. Fundoscopy revealed retinal hemorrhages throughout the inferior retinal hemisphere of the right eye. Fluorescence angiography showed extensive areas of vascular non-perfusion in the inferior retinal quadrants. The spectral domain OCT demonstrated a cystoid macular edema in the left eye. His IOP was normal in both eyes. Anterior segment examination was bilaterally unremarkable. The patient is being currently treated with intravitreal anti-VEGF therapy, with gradual improvement of vision.
Discussion
HRVO has a clinical evolution, prognosis and therapy comparable to OVCR. Thus, complications such as macular edema and neovascular glaucoma should be promptly addressed. Follow-up is dependent on the clinical picture. In the current era of anti-VEGF injections, monthly follow-up is needed with OCT for monitoring treatment response and planning therapy. Intravitreal steroids may be considered in some cases. If neovascularization develops, retinal pan-photocoagulation must be performed.
Keywords
Hemiretinal vein occlusion, retinal vein occlusion.
Area
CLINICAL CASE
Authors
Nathália Nishiyama Tondelli, Rafael Garcia, Paulo Henrique Horizonte, Henrique Leber, Luciano Fuzzato Filho, Gabriella Marranghello Mingione, Mariana da Rocha Martini, André Marcelo Vieira Gomes