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90-year-old man who I saw in the office on September 10, 2009. He recently moved to Florida from New York because his wife passed away. He had cataract surgery a little over a year ago and since the time of the cataract surgery he notices his vision in both eyes of his eyes is poor to the point where he is no longer able to read. His old chart does document that he has had branch retinal vein occlusions in both eyes in the past. It is a little difficult to sort out how long his vision has been poor. It is possible his vision in the right eye has been poor for as much as ten years. Some of the vision loss they feel previous to the cataract surgery might have been from the cataract, but it sounds like some of it might have been also from the retinal vascular occlusions. VISUAL ACUITY: OD 20/200, OS 20/200. IOP: OD 11, OS 10. SLIT EXAMINATION: The posterior chamber intraocular lens is in good position in both eyes. The left eye has a 2+ posterior capsular opacity. EXTENDED OPHTHALMOSCOPY: OD: Vertical C/D ratio is 0.2. There is an inferotemporal macular branch retinal vein occlusion. There is a well-defined, almost perfectly circular ring of pigment epithelial atrophy centrally, which is something you would see in someone who has had chronic severe cystoid macular edema for a long time. OS: Vertical C/D ratio is 0.2. There is a pigment spot under the fovea, which is hyperpigmented possibly from macular degeneration, but also from chronic macular edema. There is a superotemporal branch retinal vein occlusion affecting an area just inside the arcades. There are a few patchy retinal hemorrhages in the periphery. OCT SCAN: The OCT scan shows in the right eye retinal atrophy. The left eye shows macular edema. Photos confirm clinical findings. FLUORESCEIN ANGIOGRAPHY: Fluorescein angiography confirms a branch retinal vein occlusion in both eyes with severe capillary non profusion of the inferior half of the macula in the right eye and the superior half of the macula in the left eye. There is late leakage into the fovea in the left eye. IMPRESSION: 1. CYSTOID MACULAR EDEMA – LEFT EYE 2. MACULAR BRANCH RETINAL VEIN OCCLUSION – LEFT EYE 3. DIABETIC RETINOPATHY – LEFT EYE 4. MACULAR SCAR – RIGHT EYE 5. BRANCH RETINAL VEIN OCCLUSION – RIGHT EYE DISCUSSION: I explained to the patient unfortunately the macula has scarring and atrophy and permanent vision loss. The left eye with the macular edema though may be responsive to treatment. I suggest that we try intravitreal Kenalog today, which I injected .05 cc. I asked him to return for a check in one month, depending on how he does it may be worthwhile considering it in the future, focal laser to that area of leakage.

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New BRVO Left Eye Old BRVO Right Eye - Right Eye Showing Bulls Eye Atrophy from Chronic CME and Non-Perfusion Infero-temporally197 views90-year-old man decreased vision maybe one year since cataract surgery he is no longer able to read. OD 20/200, OS 20/20000000
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New BRVO Left Eye Old BRVO Right Eye - Right Eye Showing Bulls Eye Atrophy from Chronic CME and Non-Perfusion Infero-temporally303 views90-year-old man decreased vision maybe one year since cataract surgery he is no longer able to read. OD 20/200, OS 20/20000000
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New BRVO Left Eye Old BRVO Right Eye - Right Eye Showing Bulls Eye Atrophy from Chronic CME and Non-Perfusion Infero-temporally235 views90-year-old man decreased vision maybe one year since cataract surgery he is no longer able to read. OD 20/200, OS 20/20000000
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New BRVO Left Eye Old BRVO Right Eye - Left Eye Shows Twig Superior Vein Occlusion with Edema236 views90-year-old man decreased vision maybe one year since cataract surgery he is no longer able to read. OD 20/200, OS 20/20000000
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New BRVO Left Eye Old BRVO Right Eye - Left Eye Shows Twig Superior Vein Occlusion with Edema170 views90-year-old man decreased vision maybe one year since cataract surgery he is no longer able to read. OD 20/200, OS 20/20000000
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New BRVO Left Eye Old BRVO Right Eye - Left Eye Shows Twig Superior Vein Occlusion with Edema118 views90-year-old man decreased vision maybe one year since cataract surgery he is no longer able to read. OD 20/200, OS 20/20000000
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New BRVO Left Eye Old BRVO Right Eye - Right Eye Showing Bulls Eye Atrophy from Chronic CME and Non-Perfusion Infero-temporally104 views90-year-old man decreased vision maybe one year since cataract surgery he is no longer able to read. OD 20/200, OS 20/20000000
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New BRVO Left Eye Old BRVO Right Eye - Left Eye Shows Twig Superior Vein Occlusion with Edema104 views90-year-old man decreased vision maybe one year since cataract surgery he is no longer able to read. OD 20/200, OS 20/20000000
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New BRVO Left Eye Old BRVO Right Eye - Right Eye Showing Bulls Eye Atrophy from Chronic CME and Non-Perfusion Infero-temporally100 views90-year-old man decreased vision maybe one year since cataract surgery he is no longer able to read. OD 20/200, OS 20/20000000
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New BRVO Left Eye Old BRVO Right Eye - Right Eye Showing Bulls Eye Atrophy from Chronic CME and Non-Perfusion Infero-temporally74 views90-year-old man decreased vision maybe one year since cataract surgery he is no longer able to read. OD 20/200, OS 20/20000000
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New BRVO Left Eye Old BRVO Right Eye - Right Eye Showing Bulls Eye Atrophy from Chronic CME and Non-Perfusion Infero-temporally89 views90-year-old man decreased vision maybe one year since cataract surgery he is no longer able to read. OD 20/200, OS 20/20000000
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New BRVO Left Eye Old BRVO Right Eye 69 views90-year-old man decreased vision maybe one year since cataract surgery he is no longer able to read. OD 20/200, OS 20/20000000
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New BRVO Left Eye Old BRVO Right Eye - Left Eye Shows Twig Superior Vein Occlusion with Edema94 views90-year-old man decreased vision maybe one year since cataract surgery he is no longer able to read. OD 20/200, OS 20/20000000
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New BRVO Left Eye Old BRVO Right Eye - Left Eye Shows Twig Superior Vein Occlusion with Edema149 views90-year-old man decreased vision maybe one year since cataract surgery he is no longer able to read. OD 20/200, OS 20/20000000
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New BRVO Left Eye Old BRVO Right Eye - Left Eye Shows Twig Superior Vein Occlusion with Edema104 views90-year-old man decreased vision maybe one year since cataract surgery he is no longer able to read. OD 20/200, OS 20/20000000
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New BRVO Left Eye Old BRVO Right Eye - Left Eye Shows Twig Superior Vein Occlusion with Edema62 views90-year-old man decreased vision maybe one year since cataract surgery he is no longer able to read. OD 20/200, OS 20/20000000
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New BRVO Left Eye Old BRVO Right Eye - Left Eye Shows Twig Superior Vein Occlusion with Edema Arrow Shows Site of Occlusion100 views90-year-old man decreased vision maybe one year since cataract surgery he is no longer able to read. OD 20/200, OS 20/20000000
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New BRVO Left Eye Old BRVO Right Eye - Left Eye Shows Twig Superior Vein Occlusion with Edema78 views90-year-old man decreased vision maybe one year since cataract surgery he is no longer able to read. OD 20/200, OS 20/20000000
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New BRVO Left Eye Old BRVO Right Eye - Left Eye Shows Twig Superior Vein Occlusion with Edema49 views90-year-old man decreased vision maybe one year since cataract surgery he is no longer able to read. OD 20/200, OS 20/20000000
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brvoou_ormu_281829.png
New BRVO Left Eye Old BRVO Right Eye - Right Eye Showing Bulls Eye Atrophy from Chronic CME and Non-Perfusion Infero-temporally98 views90-year-old man decreased vision maybe one year since cataract surgery he is no longer able to read. OD 20/200, OS 20/20000000
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New BRVO Left Eye Old BRVO Right Eye - Right Eye Showing Bulls Eye Atrophy from Chronic CME and Non-Perfusion Infero-temporally75 views90-year-old man decreased vision maybe one year since cataract surgery he is no longer able to read. OD 20/200, OS 20/20000000
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New BRVO Left Eye Old BRVO Right Eye - Right Eye Showing Bulls Eye Atrophy from Chronic CME and Non-Perfusion Infero-temporally125 views90-year-old man decreased vision maybe one year since cataract surgery he is no longer able to read. OD 20/200, OS 20/20000000
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brvoou_ormu_282129.png
New BRVO Left Eye Old BRVO Right Eye - Left Eye Shows Twig Superior Vein Occlusion with Edema142 views90-year-old man decreased vision maybe one year since cataract surgery he is no longer able to read. OD 20/200, OS 20/20000000
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New BRVO Left Eye Old BRVO Right Eye - Left Eye Shows Twig Superior Vein Occlusion with Edema119 views90-year-old man decreased vision maybe one year since cataract surgery he is no longer able to read. OD 20/200, OS 20/20000000
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90-year-old man who I saw in the office on September 10, 2009. He recently moved to Florida from New York because his wife passed away. He had cataract surgery a little over a year ago and since the time of the cataract surgery he notices his vision in both eyes of his eyes is poor to the point where he is no longer able to read. His old chart does document that he has had branch retinal vein occlusions in both eyes in the past. It is a little difficult to sort out how long his vision has been poor. It is possible his vision in the right eye has been poor for as much as ten years. Some of the vision loss they feel previous to the cataract surgery might have been from the cataract, but it sounds like some of it might have been also from the retinal vascular occlusions. VISUAL ACUITY: OD 20/200, OS 20/200. IOP: OD 11, OS 10. SLIT EXAMINATION: The posterior chamber intraocular lens is in good position in both eyes. The left eye has a 2+ posterior capsular opacity. EXTENDED OPHTHALMOSCOPY: OD: Vertical C/D ratio is 0.2. There is an inferotemporal macular branch retinal vein occlusion. There is a well-defined, almost perfectly circular ring of pigment epithelial atrophy centrally, which is something you would see in someone who has had chronic severe cystoid macular edema for a long time. OS: Vertical C/D ratio is 0.2. There is a pigment spot under the fovea, which is hyperpigmented possibly from macular degeneration, but also from chronic macular edema. There is a superotemporal branch retinal vein occlusion affecting an area just inside the arcades. There are a few patchy retinal hemorrhages in the periphery. OCT SCAN: The OCT scan shows in the right eye retinal atrophy. The left eye shows macular edema. Photos confirm clinical findings. FLUORESCEIN ANGIOGRAPHY: Fluorescein angiography confirms a branch retinal vein occlusion in both eyes with severe capillary non profusion of the inferior half of the macula in the right eye and the superior half of the macula in the left eye. There is late leakage into the fovea in the left eye. IMPRESSION: 1. CYSTOID MACULAR EDEMA – LEFT EYE 2. MACULAR BRANCH RETINAL VEIN OCCLUSION – LEFT EYE 3. DIABETIC RETINOPATHY – LEFT EYE 4. MACULAR SCAR – RIGHT EYE 5. BRANCH RETINAL VEIN OCCLUSION – RIGHT EYE DISCUSSION: I explained to the patient unfortunately the macula has scarring and atrophy and permanent vision loss. The left eye with the macular edema though may be responsive to treatment. I suggest that we try intravitreal Kenalog today, which I injected .05 cc. I asked him to return for a check in one month, depending on how he does it may be worthwhile considering it in the future, focal laser to that area of leakage.