Location
Philadelphia, PA
Start Date
30-4-2025 1:00 PM
End Date
30-4-2025 4:00 PM
Description
Introduction
This case report presents a patient diagnosed with central retinal vein occlusion (CRVO) concomitant with cilioretinal artery occlusion (CLRAO) in their right eye. The diagnosis was established through a dilated fundus examination, fluorescein angiography, optical coherence tomography (OCT), and fundus photography. The occurrence of CRVO in conjunction with CLRAO is rare, representing a unique and noteworthy clinical presentation.
The clinical manifestation of CRVO typically includes optic disc hyperemia, dilation and tortuosity of veins, and extensive retinal edema and hemorrhage. Disruption of the blood-retinal barrier consequently leads to edema and disruption of the vascular endothelium leads to hemorrhages, which can ultimately be seen on fluorescein angiography as leakage of dye from capillaries.
The central retinal artery, the cilio-retinal artery, and the central retinal vein all share a common exit point through the optic nerve. An associated CLRAO with CRVO has been hypothesized and attributed to the rapid increase in intraluminal pressure within the retinal capillary network from the venous stasis following a CRVO, subsequently surpassing the pressure within the cilioretinal artery and resulting in the obstruction of blood flow in the cilioretinal artery.
Methods
Case Report and Literature Review
Results
The clinical presentation of this patient’s painless, sudden loss of vision was consistent with a diagnosis of CRVO with CLRAO, confirmed with OCT and fluorescein angiography. Initially, it appeared nonischemic due to non-severe hemorrhage, vision greater than 20/200, absence of afferent pupillary defect, and absence of cotton wool spots. At his 2-week follow up visit, his vision had decreased, and OCT revealed severe macular edema with outer retina disruption, raising concern for ischemic conversion. Intravitreal injections of 1.25mg bevacizumab was initiated.
Conclusion
Healthy blood circulation is vital for efficiently circulating oxygen and nutrients to all parts of the body, including to the eye. The main vessels of the inner retina are the central retinal artery and the central retinal vein, which supply and drain the retina. With the compromised blood, oxygen, and nutrient flow, the retina becomes ischemic. This leads to damage at a cellular level, leading to an upregulation of cytokines, and angiogenic factors including vascular endothelial growth factors (VEGF). VEGF, a very potent angiogenic protein, leads to retinal and choroidal neovascularization, as well as vascular permeability resulting in retinal edema. With prolonged obstruction in retinal perfusion, permanent ganglion cell death can occur leading to irreversible vision loss. For this reason, prompt treatment is recommended. The occurrence of CRVO in conjunction with CLRAO is rare, representing a unique and noteworthy clinical presentation.
Embargo Period
11-29-2025
Combined CRVO + CLRAO – A Case Report
Philadelphia, PA
Introduction
This case report presents a patient diagnosed with central retinal vein occlusion (CRVO) concomitant with cilioretinal artery occlusion (CLRAO) in their right eye. The diagnosis was established through a dilated fundus examination, fluorescein angiography, optical coherence tomography (OCT), and fundus photography. The occurrence of CRVO in conjunction with CLRAO is rare, representing a unique and noteworthy clinical presentation.
The clinical manifestation of CRVO typically includes optic disc hyperemia, dilation and tortuosity of veins, and extensive retinal edema and hemorrhage. Disruption of the blood-retinal barrier consequently leads to edema and disruption of the vascular endothelium leads to hemorrhages, which can ultimately be seen on fluorescein angiography as leakage of dye from capillaries.
The central retinal artery, the cilio-retinal artery, and the central retinal vein all share a common exit point through the optic nerve. An associated CLRAO with CRVO has been hypothesized and attributed to the rapid increase in intraluminal pressure within the retinal capillary network from the venous stasis following a CRVO, subsequently surpassing the pressure within the cilioretinal artery and resulting in the obstruction of blood flow in the cilioretinal artery.
Methods
Case Report and Literature Review
Results
The clinical presentation of this patient’s painless, sudden loss of vision was consistent with a diagnosis of CRVO with CLRAO, confirmed with OCT and fluorescein angiography. Initially, it appeared nonischemic due to non-severe hemorrhage, vision greater than 20/200, absence of afferent pupillary defect, and absence of cotton wool spots. At his 2-week follow up visit, his vision had decreased, and OCT revealed severe macular edema with outer retina disruption, raising concern for ischemic conversion. Intravitreal injections of 1.25mg bevacizumab was initiated.
Conclusion
Healthy blood circulation is vital for efficiently circulating oxygen and nutrients to all parts of the body, including to the eye. The main vessels of the inner retina are the central retinal artery and the central retinal vein, which supply and drain the retina. With the compromised blood, oxygen, and nutrient flow, the retina becomes ischemic. This leads to damage at a cellular level, leading to an upregulation of cytokines, and angiogenic factors including vascular endothelial growth factors (VEGF). VEGF, a very potent angiogenic protein, leads to retinal and choroidal neovascularization, as well as vascular permeability resulting in retinal edema. With prolonged obstruction in retinal perfusion, permanent ganglion cell death can occur leading to irreversible vision loss. For this reason, prompt treatment is recommended. The occurrence of CRVO in conjunction with CLRAO is rare, representing a unique and noteworthy clinical presentation.