A woman in her 60s with hypertension presented with acute left patchy scotoma. The right eye was amblyopic due to an old macular scar. Visual acuity was 20/200 OD and 20/40 OS. Left eye examination showed perivenular whitening in the macula, dilated veins in all 4 quadrants, and a few dot hemorrhages (Figure, A). Autofluorescence scan showed fernlike distribution of hypoautofluorescence at the macula (Figure, B). This was diagnosed as central retinal vein occlusion. She subsequently developed additional intraretinal hemorrhages and macular edema, requiring 3 injections of intravitreal aflibercept (EYLEA), 2.0 mg, with visual acuity maintained at 20/40 through 6 months of follow-up.
Lai WKL, Elgohary MA. Fernlike Maculopathy in a Patient With Central Retinal Vein Occlusion. JAMA Ophthalmol. 2016;134(6):e156131. doi:10.1001/jamaophthalmol.2015.6131