1. Retinal vein occlusion is a common retinal vascular disease caused by occlusion of retinal veins. Central retinal vein occlusion blocks the central retinal vein while branch retinal vein occlusion blocks smaller retinal veins. 2. Presentation includes sudden blurred vision, retinal hemorrhages, edema, and tortuous veins. Central retinal vein occlusion can be ischemic or non-ischemic depending on extent of occlusion. 3. Management depends on severity and includes treating any underlying conditions, observation, anti-VEGF injections, laser therapy, and sometimes surgery for complications like tractional retinal detachment.

1. RETINA – RETINAL VEIN OCCLUSION 28th May2020
May 2020AL KERATITIS
DR M SAQUIB
MBBS,MS , FSCEH DELHI,FHVDESAI PUNE,
EX REGISTRARA JNMCH,AMU
CONSULTANT OPHTHALMOLOGIST
HOD D/O OPHTHALMOLOGY
G.S .MEDICAL COLLEGE
Founder sec: MEDICS India ,
Mail-dms2k5@gmail.com , 9634123800

2. Sohan S. Hayreh,
• MD, MS, PhD, DSc, FRCS, FRCOphth. Emeritus Professor of Ophthalmology and Visual Sciences. Contact Information. Primary
Office 111290 PFP Iowa City, IA 52242 319-356-2947. sohan-hayreh@uiowa.edu. The Ocular Vascular VClinic . Education MB,
Panjab University BS, (Bachelor of Medicine & Surgery) (Equivalent to M.D. in the U.S.), Panjab University MBBS, Master of
Surgery, …

3. • Retinal vein occlusion (RVO) is the most common retinal
vascular disease after diabetic retinopathy.
• RVO > RAO
• 60-70 Years
• Central RVO (CRVO), the occlusion is at or proximal to
the lamina cribrosa of the optic nerve, where the central
retinal vein exits the eye.
• CRVO is further divided into the categories of perfused
(nonischemic) and nonperfused (ischemic).

4. Arteriosclerotic changes in the central retinal artery.
Becomes rigid and impinges upon the thinner vein, causing hemodynamic
disturbances, endothelial damage, and thrombus
formation.

7. ETIOLOGY
• Age - > 55
• Atheroclerosis of Retinal Artery
• Hypertension
• Hyperlipidaemia
• OCP
• Diabetes
• Periphlebitis – Syphilis , SLE , SARCOIDOSIS
• Raised IOP- OAG
• Local Cause- Orbital cellulitis, Orbital tumour ,CST

8. CRVO and Systemic Disease
• Carotid Artery Disease
• Antithrombin Deficiency
• Hypercholesteremia
• Hyperlipidemia
• Mitral Valve Prolapse
• Hypercoagulopathies

9. Presentation
• Sudden,
• unilateral
• Blurred vision; in non-ischemic CRVO, the
blurring is mild and may be worse on waking and
improves during the day.
• In ischemic CRVO, visual impairment is sudden
and severe.

10. Classification
• Depending on the area of retinal venous drainage
effectively occluded
• Central Retinal Vein Occlusion (CRVO),
• Hemispheric Retinal Vein Occlusion (HRVO), or
• Branch Retinal Vein Occlusion (BRVO).
• Hayreh observed that each of these has two
subtypes.
Ischemic and Nonischemic CRVO

11. Signs
• Retinal edema.
• Superficial hemorrhages.
• Disc swelling.
• Cotton wool spots.
• Tortuous and dilated
retinal veins

14. Non Ischemivc CRVO
Venous Stasis Retinopathy
• Most common
• Mild to Moderate visual loss
• No RAPD
• Visual Field
• ERG

15. Early Non –Ischemic CRVO:
Venus congestion or tortuosity
Superficial Haemorhage Peripheral Retina
,Mild Disc Oedema, Macular Oedema +/-
Late ( 6-9 Month ) Non Ischemic CRV0
Venous sheathing
Cilioretinal Collateral around Disc
Chronic CME
Absorbed Retinal Haemorhages
15% converted to Ischemic CRVO

16. Ischemic CRVO (Nonperfused)
Haemorhagic Retinopathy
• Ischemic CRVO is characterized by rapid onset venous
obstruction resulting in decreased retinal perfusion,
capillary closure and retinal hypoxia. Patients with severe
central retinal vein obstruction typically have severe
visual loss, usually less than 20/200; a marked afferent
pupillary defect; severe tortuosity and engorgement of all
branches of the central retinal vein, extensive deep blot
and flame-shaped hemorrhages involving the peripheral
retina and posterior pole, severe disc edema and
hyperemia.

19. CRVO

20. • This may lead to profound vascular leakage, rubeosis
iridis and raised intraocular pressure. The prognosis is
extremely poor due to macular ischemia. Rubeosis iridis
develops in about 50% of eyes, usually between 2 and 4
months (90-day glaucoma), and there is a high risk of
neovascular glaucoma. Retinal neovascularization occurs
in about 5% of eyes. Where possible, patients with
ischemic CRVO should be seen monthly for 6 months to
detect the onset of anterior segment neovascularization.
Subsequent review should usually be for up to 2 years to
detect significant ischemia and macular oedema[3]

21. Chronic CRVO Ischemic

22. Non Ischemic Chronic CRVO

23. Branch Retinal Vein Occlusion (BRVO)
• Common than CRVO
• Hemispheric Vein Occlusion
• Quadrantic occlusion at AV Crossing
• Small Branch Occlusion

25. Hemi Retinal Vein Occlusion

26. BRVO

27. • Area specific to vein affected
• Retinal Oedema
• Haemorrhage
• Secondary Glaucoma
• Chronic Macular oedema
• Neovascularisation

28. O/E
• Visual acuity
• IOP –POAG
• Slit Lamp – Undilated -
Neovascularisation of Iris (NVI)
Gonioscopy – Neovascularisation of Iris
Fundus – Direct /Indirect ,SLE with +78 D /+90 D

29. Investigation
• Perimetry
• ERG
• Fundus Fluoroscein Angiography (FFA)Area > 10
Disc Diameter –Ischemic CRVO, Capillary Non
Perfusion
• OCT –Macular Oedema, Subretinal Fluid ,
Epiretinal Membrane

30. Systemic
• Hypertension
• Diabetes Mellitus
• Lipid Profile
• Heart Disease
• Dyslipidaemia
• Hypercoagulable Condition
• Homocysteinosis

31. Differential Diagnosis
• Diabetic Retinopathy – Bilateral
• Ocular ischemic Syndrome –
Carotid Occlusive disease
Dilated Vein without Tortousity
Retinal Haemorrhage Mid Periphery

32. Management
• Treatment Systemic
• Ocular Association – POAG
• Observation
• Mild to Moderate Vision loss- VA> 6/18
• Non Ischemic CRVO , > 50 % Resolve

34. Intravitreal Injection
Bevacizumab-Avasti- 1.25 mg
Ranibizumab – Lucentis - 0.3 mg
Triamcinolone – 1mg /0.1 ml

35. LASER THERAPY
• Grid LASER – Persistent CME
• PRP-
• NVE/NVD/NVI Neovascularisation anywhere
• Scatter LASER – Neovascularisation Elswhere (
NVE) in BRVO

36. Surgical
• Pars Plana Vitrectomy
• Indications :
• Persistent Vitreous Haemorhage
• Traction RD
• Epiretinal Membrane
• Interactable Neovascular Glaucoma