PMC4445948_01
Color fundus photograph of the left eye demonstrates dilated, tortuous retinal veins with intraretinal hemorrhages in all four quadrants.
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Left fundus exam revealed retinal hemorrhages in all four quadrants with venous dilation and tortuosity and a small vitreous hemorrhage (Figure 1).
Fluorescein angiogram, left eye.. Notes: (A) Arterial phase of fluorescein angiography of the left eye demonstrates normal arterial filling with blockage of choroidal fluorescence by retinal hemorrhages. (B) Delayed venous filling and venous tortuosity and dilation are evident in the arteriovenous phase. (C) Normal choroidal perfusion persists through the venous phase without evidence of leakage or vasculitis.
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Fluorescein angiography revealed delayed venous filling without leakage, vasculitis, or choroidal ischemia; suggestive of non-ischemic central retinal vein occlusion (CRVO, Figure 2).
In the left eye, the bifurcation of the central retinal artery sits atop a segment of the central retinal vein at the site of obstruction (bracket).. Notes: The tight anatomical relationship is accentuated by an undilated nasal retinal vein firmly wrapped around the arterial bifurcation (arrowhead). The veins that emanate from underneath the artery are dilated and tortuous.
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Upon closer review of the nerve anatomy, the arteries were found to lie directly over the veins with the vessels tightly intertwined in the left eye (Figure 3).
In the unaffected right eye, no intertwining of the vessels is seen.
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No such vascular intertwining was present in the unaffected right eye (Figure 4).