Last additions - CRVO Hemorrhage 66-year-old woman has a central retinal vein occlusion in the right eye with macular edema. She had intravitreal Lucentis treatments monthly. The last treatment was six weeks ago and she has noticed over the last week or two her vision is declining.
VISUAL ACUITY: OD 20/70, OS 20/30. IOP: OD 17. The right eye has 2+ nuclear sclerotic cataract.
EXTENDED OPHTHALMOSCOPY:
OD: Vertical C/D ratio is 0.1. There are optociliary shunt vessels on the optic nerve. There is 2+ cystoid macular edema. There are patchy retinal hemorrhages and dilated retinal veins.
OCT SCAN: The OCT scan shows recurrent macular edema.
Photos confirm clinical findings.
FLUORESCEIN ANGIOGRAM: Shows temporal nonperfusion almost up to the center of the fovea.
IMPRESSION:
1. CENTRAL RETINAL VEIN OCCLUSION – RIGHT EYE
2. RESOLVED MACULAR EDEMA – RIGHT EYE
3. PERIPHERAL NONPERFUSION – RIGHT EYE
DISCUSSION: I explained to the patient with the recurrent macular edema, I think it is reasonable to restart Lucentis treatment, but also supplement laser to try to prevent recurrence again. I did a focal laser today trying to create a chorioretinal anastomosis. I asked her to return in a week for a Lucentis treatment and subsequent to that I will add a panretinal laser, especially the temporal periphery.
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Central Retinal Vein Occlusion Recurrent Edema 6 weeks after Lucentis - Nonperfusion Temporally590 views66-year-old woman has a central retinal vein occlusion in the right eye with macular edema. She had intravitreal Lucentis treatment six weeks ago and she has noticed over the last week or two her vision is declining.
VISUAL ACUITY: OD 20/70, OS 20/30. Jun 25, 2011
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Central Retinal Vein Occlusion Recurrent Edema 6 weeks after Lucentis - Nonperfusion Temporally526 views66-year-old woman has a central retinal vein occlusion in the right eye with macular edema. She had intravitreal Lucentis treatment six weeks ago and she has noticed over the last week or two her vision is declining.
VISUAL ACUITY: OD 20/70, OS 20/30. Jun 25, 2011
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Central Retinal Vein Occlusion Recurrent Edema 6 weeks after Lucentis - Nonperfusion Temporally518 views66-year-old woman has a central retinal vein occlusion in the right eye with macular edema. She had intravitreal Lucentis treatment six weeks ago and she has noticed over the last week or two her vision is declining.
VISUAL ACUITY: OD 20/70, OS 20/30. Jun 25, 2011
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Central Retinal Vein Occlusion Recurrent Edema 6 weeks after Lucentis - Nonperfusion Temporally554 views66-year-old woman has a central retinal vein occlusion in the right eye with macular edema. She had intravitreal Lucentis treatment six weeks ago and she has noticed over the last week or two her vision is declining.
VISUAL ACUITY: OD 20/70, OS 20/30. Jun 25, 2011
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Central Retinal Vein Occlusion Recurrent Edema 6 weeks after Lucentis - Nonperfusion Temporally482 views66-year-old woman has a central retinal vein occlusion in the right eye with macular edema. She had intravitreal Lucentis treatment six weeks ago and she has noticed over the last week or two her vision is declining.
VISUAL ACUITY: OD 20/70, OS 20/30. Jun 25, 2011
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Central Retinal Vein Occlusion Recurrent Edema 6 weeks after Lucentis - Nonperfusion Temporally447 views66-year-old woman has a central retinal vein occlusion in the right eye with macular edema. She had intravitreal Lucentis treatment six weeks ago and she has noticed over the last week or two her vision is declining.
VISUAL ACUITY: OD 20/70, OS 20/30. Jun 25, 2011
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Central Retinal Vein Occlusion Recurrent Edema 6 weeks after Lucentis - Nonperfusion Temporally445 views66-year-old woman has a central retinal vein occlusion in the right eye with macular edema. She had intravitreal Lucentis treatment six weeks ago and she has noticed over the last week or two her vision is declining.
VISUAL ACUITY: OD 20/70, OS 20/30. Jun 25, 2011
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Central Retinal Vein Occlusion Recurrent Edema 6 weeks after Lucentis - Nonperfusion Temporally444 views66-year-old woman has a central retinal vein occlusion in the right eye with macular edema. She had intravitreal Lucentis treatment six weeks ago and she has noticed over the last week or two her vision is declining.
VISUAL ACUITY: OD 20/70, OS 20/30. Jun 25, 2011
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Central Retinal Vein Occlusion Recurrent Edema 6 weeks after Lucentis - Nonperfusion Temporally470 views66-year-old woman has a central retinal vein occlusion in the right eye with macular edema. She had intravitreal Lucentis treatment six weeks ago and she has noticed over the last week or two her vision is declining.
VISUAL ACUITY: OD 20/70, OS 20/30. Jun 25, 2011
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Central Retinal Vein Occlusion Recurrent Edema 6 weeks after Lucentis - Nonperfusion Temporally634 views66-year-old woman has a central retinal vein occlusion in the right eye with macular edema. She had intravitreal Lucentis treatment six weeks ago and she has noticed over the last week or two her vision is declining.
VISUAL ACUITY: OD 20/70, OS 20/30. Jun 25, 2011
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Central Retinal Vein Occlusion Recurrent Edema 6 weeks after Lucentis - Nonperfusion Temporally492 views66-year-old woman has a central retinal vein occlusion in the right eye with macular edema. She had intravitreal Lucentis treatment six weeks ago and she has noticed over the last week or two her vision is declining.
VISUAL ACUITY: OD 20/70, OS 20/30. Jun 25, 2011
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Central Retinal Vein Occlusion Recurrent Edema 6 weeks after Lucentis - Nonperfusion Temporally564 views66-year-old woman has a central retinal vein occlusion in the right eye with macular edema. She had intravitreal Lucentis treatment six weeks ago and she has noticed over the last week or two her vision is declining.
VISUAL ACUITY: OD 20/70, OS 20/30. Jun 25, 2011
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Central Retinal Vein Occlusion Recurrent Edema 6 weeks after Lucentis - Nonperfusion Temporally456 views66-year-old woman has a central retinal vein occlusion in the right eye with macular edema. She had intravitreal Lucentis treatment six weeks ago and she has noticed over the last week or two her vision is declining.
VISUAL ACUITY: OD 20/70, OS 20/30. Jun 25, 2011
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Central Retinal Vein Occlusion Recurrent Edema 6 weeks after Lucentis - Nonperfusion Temporally664 views66-year-old woman has a central retinal vein occlusion in the right eye with macular edema. She had intravitreal Lucentis treatment six weeks ago and she has noticed over the last week or two her vision is declining.
VISUAL ACUITY: OD 20/70, OS 20/30. Jun 25, 2011
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Central Retinal Vein Occlusion Recurrent Edema 6 weeks after Lucentis - Nonperfusion Temporally762 views66-year-old woman has a central retinal vein occlusion in the right eye with macular edema. She had intravitreal Lucentis treatment six weeks ago and she has noticed over the last week or two her vision is declining.
VISUAL ACUITY: OD 20/70, OS 20/30. Jun 25, 2011
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66-year-old woman has a central retinal vein occlusion in the right eye with macular edema. She had intravitreal Lucentis treatments monthly. The last treatment was six weeks ago and she has noticed over the last week or two her vision is declining.
VISUAL ACUITY: OD 20/70, OS 20/30. IOP: OD 17. The right eye has 2+ nuclear sclerotic cataract.
EXTENDED OPHTHALMOSCOPY:
OD: Vertical C/D ratio is 0.1. There are optociliary shunt vessels on the optic nerve. There is 2+ cystoid macular edema. There are patchy retinal hemorrhages and dilated retinal veins.
OCT SCAN: The OCT scan shows recurrent macular edema.
Photos confirm clinical findings.
FLUORESCEIN ANGIOGRAM: Shows temporal nonperfusion almost up to the center of the fovea.
IMPRESSION:
1. CENTRAL RETINAL VEIN OCCLUSION – RIGHT EYE
2. RESOLVED MACULAR EDEMA – RIGHT EYE
3. PERIPHERAL NONPERFUSION – RIGHT EYE
DISCUSSION: I explained to the patient with the recurrent macular edema, I think it is reasonable to restart Lucentis treatment, but also supplement laser to try to prevent recurrence again. I did a focal laser today trying to create a chorioretinal anastomosis. I asked her to return in a week for a Lucentis treatment and subsequent to that I will add a panretinal laser, especially the temporal periphery.
