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Branch Retinal Vein Occlusion (BRVO)

Background

 

  • BRVO is three times as common as CRVO

  • may affect superotemporal / superonasal / inferotemporal / inferonasal arcade

    • ​arcade =  ​large bundles of retinal vessels - arterial and venous​

    • superotemporal arcade is most commonly affected​ by BRAO

  • BRAO typically arises from a point where a retinal arteriole crosses over a branch of a retinal vein (known as a 'nipping point')

    • BRVO occurs as a result of atherosclerotic disease within the arteriole wall which causes vessel damage and thrombus formation within the retinal vein branch

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Presentation

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  • ​may be asymptomatic

    • visual changes will occur if the macula is affected​

  • reduced visual acuity

  • visual field defect

  • metamorphospia (distortion of vision)

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Examination findings

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  • Examination of the retina in acute BRVO:

    • cotton wool spots

    • dot, blot and flame haemorrhages - confined to region that the affected vein branch normally drains

    • oedema surrounding one engorged vein​ which follows a tortuous path

    • oedema (fluid leakage from vessels leading to swelling) of the macula region of the retina

  • Chronic changes:

    • ​​down the line, neovascularisation (new vessel growth) on the retina may occur

      • these vessels can bleed into the vitreous (vitreous haemorrhage)​

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Treatment

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  • Conservative management if vision is preserved - observation

  • Treat co-existing hypertension +- hyperlipidaemia

  • Intravitreal steroid injection / implant

  • anti-VEGF injections (helps to treat macula oedema and neovascularisation)

  • Laser - photocoagulation, if there is neovascularisation

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References

  • Denniston, A. K. O. and Murray, P. I. (eds) (2018) Oxford handbook of ophthalmology. 4th edn. London, England: Oxford University Press (Oxford Medical Handbooks). doi: 10.1093/med/9780198804550.001.0001.

  • James, B., Bron, A. J. and Parulekar, M. V. (2016) Lecture Notes Ophthalmology. 12th edn. Nashville, TN: John Wiley & Sons (Lecture Notes)

  • Salmon, J. F. (2019) Kanski’s clinical ophthalmology. 9th edn. London, England: Elsevier Health Sciences.

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