HRVO Case Presentation.pptx

hemiretinal vein occlusion

1. Case presentation Presenter: Dr. Shubhangi Mahesh Junior Resident Department of Ophthalmology MGM Hospital, Kamothe .

2. Patient D etail s Name : Nazmabegum Khan Age: 56 yrs Sex: Female Religion: Muslim Address: Taloja

3. History Patient came with the chief complaints of diminution of distant as well as near vision in the right eye, since 3-4 days which was sudden in onset, non-progressive and painless in nature History of spectacle usage since 15 years, last corrected 2 years ago No history of ocular trauma No history of ocular surgery/procedure. No history of past COVID infection. K/c/o Type II diabetes mellitus since 10 years on oral medication K/c/o Thyroid disorder since 5 years on medication

4. Visual Acuity Distant Vision (Snellen’s chart) Right Eye Left Eye Unaided Pinhole Fc at 2m 6/24 6/18 NI Aided S/A 6/18 +1.50 DS/ -2.00 DC * 10 6/9 -0.75 DS/ -3.50 DC * 10 Near Vision Right Eye Left Eye Unaided N36 N10 Aided S/A N18 +2.25 DS N6 +2.25 DS Colour Vision 17/17 plates 17/17 plates Amslers Grid Normal Normal

5. Ocular E x a m i nat i on Slit Lamp Examination OD OS Eyelid Normal Normal Conjunctiva Normal Normal Sclera Normal Normal Cornea Arcus senilis Arcus senilis Anterior chamber Normal depth Normal depth Iris Normal Normal Pupil 3mmRRR; No RAPD 3mmRRR; No RAPD Lens SIMC: NSII SIMC: NSII + Diffuse PSC

6. OD OS IOP 12 mmHg 12 mmHg Sac Patent Patent Extraocular movements Free, full and painless in all gazes Free, full and painless in all gazes

7. Fundus E x a m i nat i on OD OS Distant Direct Ophthalmoscopy Red reflex seen Red reflex seen with diffuse media opacity Media Clear Clear Optic Disc Size: Normal Shape: Normal Colour: Yellowish orange Margins: Well-defined Neuroretinal rim: Healthy, temporal crescent+ Size: Normal Shape: Normal Colour: Yellowish orange Margins: Well-defined Neuroretinal rim: Healthy, temporal crescent+ C:D ratio 0.5:1 CDR 0.5:1 CDR Blood Vessels Dilated and tortuous vessels superiorly Scattered flame-shaped haemorrhages in superior hemisphere A:V ratio = 2:3, tortuous Foveal Reflex Details not seen Dull Macula Flame-shaped haemorrhages Normal

8. OD OS Indirect Ophthalmoscopy: Peripheral Retina Scattered flame-shaped haemorrhages in superior hemisphere Normal 90D slit lamp biomicroscopy with red-free filter Scattered flame-shaped haemorrhages in superior hemisphere No evidence of RNFL defects or retinal ischemia Normal

9. Fundus Photo (OD and OS)

10. OD Fundus Photo (Red-Free Filter)

11. Optical Coherence Tomography (OCT)

12. Perimetry

13. Provisional D i agno s i s Based on history and clinical examination : Patient Mrs.Nazmabegum Khan, 5 6 years old female has right eye hemiretinal vein occlusion

14. Retinal venous occlusive disease, which includes central retinal vein occlusions (CRVOs),  hemiretinal vein occlusions (HRVOs), and branch retinal vein occlusions (BRVOs), is the second most common retinal vascular disorder after diabetic retinopathy.  Vein occlusions typically affect persons older than 50 years of age who may typically have associated hypertension, cardiovascular disease, diabetes mellitus, and/or glaucoma. Variant of CRVO; May be ischaemic or non- ischaemic Occlusion of the superior or inferior branch of the central retinal vein (CRV) H emispheric occlusion - blocks a major branch of the CRV at or near the optic disc. H emicentral occlusion – involves one trunk of a dual-trunked CRV that has persisted in the anterior part of the optic nerve head as a congenital variant; less common Extensive retinal ischaemia implies a risk of neovascular glaucoma HRVO and CRVO are believed to result from thrombus formation near the lamina cribosa In approximately 20 percent of eyes, the veins draining the inferior and superior halves of the retina merge posterior to the lamina cribrosa, such that one of these two veins may be spared by the occlusive process resulting in a HRVO. The pathophysiology of HRVO mimics CRVO, but the clinical findings and complications are intermediate between CRVO and BRVO. For most clinicians, macular edema following HRVO is managed similar to that following BRVO, while CRVO guidelines are used for panretinal photocoagulation. Discussion

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