Branch Retinal Vein Occlusion followed by Central Retinal Vein Occlusion

A 59-year-old woman with history of noninsulin dependent diabetes mellitus and systemic hypertension presented with decreased vision in her left eye since 2 months ago. Bestcorrected visual acuity (BCVA) was 20/20 and 20/400 in the right and left eyes respectively. Relative afferent pupillary defect was negative. Anterior segment examination was unremarkable except for mild posterior subcapsular cataracts bilaterally. Funduscopy (Fig. 1) revealed sectoral retinal hemorrhage with macular edema and neurosensory retinal detachment due to inferotemporal branch retinal vein occlusion (BRVO). Basic laboratory tests, cardiologic consultation, fluorescein angiography (Fig. 2) and optical coherence tomography (Fig. 3) were obtained, followed by two intravitreal injections of 1.25 mg bevacizumab (IVB) in the left eye 2 months apart. BCVA improved to 20/80 in the left eye 2 months after the second injection. Post-treatment features are shown in figures 4 to 6. One year later the patient presented with reduced vision in the same eye and visual acuity of 20/800. Funduscopy disclosed diffuse retinal hemorrhage and macular edema due to central retinal vein occlusion (CRVO, Fig. 7). Fluorescein angiographic findings are shown in figure 8.