Simultaneous Branch Retinal Artery and Central Retinal Vein Occlusion Improved with No Ocular Therapy: A Case Report

Abstract

A rarely described condition known as branch retinal artery occlusion (BRAO) with concurrent obstruction of the central retinal vein (CRVO) is characterized by diffuse retinal hemorrhages, dilated and tortuous retinal veins, macular and disc edema, cotton wool spots, and a generalized delay in arteriovenous transit on fluorescein angiography, together with a retinal whitening in the area of the affected retinal arterial branch. Although BRAO and CRVO may share underlying systemic risk factors, the pathogenesis of combined BRAO + CRVO is still unknown. We present a BRAO + CRVO case report concerning a 63-year-old white male who came to our observation complaining of sudden vision loss in his right eye. An increased risk for thrombotic event was revealed in this case, and the patient improved only with systemic anticoagulant therapy and in the absence of ocular therapy. We also explain all the clinical findings that are detectable using different diagnostic devices and analyze the scientific literature for other, similar clinical cases.

Keywords: BRAO; CRVO; branch retinal artery occlusion; central retinal vein occlusion; multimodal imaging.

Figure 1

Fluorescein angiography of the right eye at different times in the examination. (a) At 13 s, the complete filling of the supero-temporal arterial branch is shown, with the incomplete and delayed filling of the infero-temporal branch and some segments (red arrow). (b) At 16 s, the presence of a capillary network at the posterior pole in the superior sector, and its absence in the inferior sector, is well shown. The initial laminar filling of the superior veins, and a slight delay in the temporal inferior one, can be observed. There is a progressive venous filling that completes at 22 s (c) in the upper sectors, and at 36 s (d) in the lower sectors. Non-perfused arteries and areas can be seen in the affected retina on the temporal inferior side.

Figure 2

Color fundus photography at diagnosis (a). It is possible to see retinal hemorrhages (yellow arrows), temporal retinal veins (white arrows), and temporal retinal arteries (green arrows), with the pale area corresponding to the area of branch retinal artery occlusion (red circle). The same fundus is shown one week later (b), and six weeks after diagnosis (c). The progressive improvement in the clinical picture is evident, with the gradual disappearance of retinal hemorrhages and the reduction in retinal whitening.

Figure 3

OCT images at diagnosis (a), and one week (b), three weeks (c), and six weeks (d) after diagnosis. The different images show the progressive subfoveal (yellow arrow) and intraretinal (white arrow) fluid decreasing with the gradual reduction in the retinal thickness and also the progressive reduction in the hyperreflectivity of the internal retinal layers, corresponding to the area of paracentral acute middle maculopathy (green arrows), an OCT sign that could be typical of retinal arterial occlusions. The red arrow indicates the posterior hyaloid.