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JAMA Ophthalmology Clinical Challenge
September 16, 2021

Bilateral Central Retinal Vein Occlusion: A Presenting Sign of an Ongoing Life-threatening Condition

Author Affiliations
  • 1Department of Ophthalmology, Centro Hospitalar e Universitário de São João, Porto, Portugal
  • 2Department of Surgery and Physiology, Faculty of Medicine of University of Porto, Porto, Portugal
  • 3Cardiovascular R&D Center, Faculty of Medicine of the University of Porto, Porto, Portugal
  • 4KULeuven, Research Group Ophthalmology, Department of Neurosciences, Leuven, Belgium
JAMA Ophthalmol. 2021;139(11):1242-1243. doi:10.1001/jamaophthalmol.2021.0993

A 47-year-old woman, with dyslipidemia, presented to the emergency department with sudden vision loss in the right eye. Visual acuity was 20/40 OD and 20/20 OS. Anterior segment, tonometry, and pupillary light reflex were unremarkable. Ophthalmoscopy of the right eye showed discretely blurred optic disc margins, tortuous and dilated retinal veins, and intraretinal hemorrhages in all quadrants; the left eye was unremarkable. An optical coherence tomography (OCT) scan showed a cystoid macular edema (CME) in the right eye; the left was unremarkable. Retinal nerve fiber layer thickness was 133 μm OD and 82 μm OS (reference value, 95.4 ± 10.48 μm).1 A fluorescein angiography was scheduled. One week later, the patient returned to our department due to multiple episodes of amaurosis fugax in left eye. By that time, ophthalmoscopy disclosed a mild optic disc swelling, tortuous venous vessels, and retinal hemorrhages bilaterally (Figure 1). The OCT scan showed a CME spontaneous resolution in the right eye while the left eye was unremarkable. Fluorescein angiography revealed a slight delay in venous filling but no capillary nonperfusion areas. These features were compatible with bilateral nonischemic central retinal vein occlusion (CRVO), with spontaneous reperfusion in the right eye.

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