ATYPICAL RETINAL VASCULAR OCCLUSION IN A GLAUCOMATOUS EYE

Atrium

Introduction. Patients with glaucoma may develop retinal vascular occlusions as both conditions are more prevalent in the elderly and often share concurrent morbidities. Case presentation. A 50 year old female with a 33 year history of cerebrovascular accident and 10 year history of treated POAG presented urgently complaining of sudden loss of vision in her right eye of 6 hours duration. Corrected BCVA diminished from a previous level of 20/25 to 20/100 with a grade 3 RAPD never present before. Fundus examination revealed scattered intraretinal hemorrhages with dilated, non-tortuous retinal veins and an ischemic retina with a cherry-red macula. The ischemic retina followed the tributaries of the retinal venules rather than the arterioles. The patient was tentatively diagnosed with a combined retinal artery and vein occlusion. The patient received additional ocular hypotensive agents and digital massage during the visit. Optical coherence tomography demonstrated neither retinal thickening nor atrophy. Fluorescein angiography was normal and surprisingly demonstrated no leakage or macular ischemia. At the 3 week follow up, the patient's right fundus demonstrated profound retinal hemorrhaging consistent with a central retinal vein occlusion. There was no ophthalmoscopically visible retinal ischemia at this visit. Her BCVA had spontaneously improved to 20/30 and her RAPD had diminished to grade 1. At her most recent follow up 4 weeks later, the retinal hemorrhages resolved, her vision improved to 20/25, and the RAPD had completely disappeared. Deviation From the Expected. This case details an unusual retinal vascular occlusion with ophthalmoscopic features of both retinal artery and vein occlusion with spontaneous resolution and disappearance of a RAPD over several weeks. Discussion. Retinal artery and vein occlusions typically have characteristic appearances and natural histories. In the case of retinal artery occlusions, the sudden hypoxia typically results in permanent visual impairment. Conclusion. This case details an unusual retinal vascular occlusion with ophthalmoscopic features of both retinal artery and vein occlusion with spontaneous resolution and disappearance of a RAPD over several weeks. Grants. None