Abstract

Central retinal vein occlusion (CRVO) is a common cause of vision impairment which can occur at any given age. Most of the cases are unilateral; bilateral cases are rare, usually having an underlying systemic illness. We report a rare challenging case of bilateral simultaneous central retinal vein occlusion (CRVO) without association of any systemic disease. A 60 year-old Asian Indian female presented with complaints of sudden painless diminution of vision in the right eye followed by left eye. There was no history of any other ocular complaints, trauma, or any ocular intervention. The systemic history was unremarkable. Anterior segment examination revealed a clear cornea with dilated fixed pupil, neovascularization of iris in right eye and semi dilated sluggish reacting pupil in left eye. Fundoscopy showed right eye media hazy due to resolving vitreous hemorrhages, vessels were dilated and tortuous with multiple flame-shaped hemorrhages in all four quadrants of both eyes and vascular sheathing in left eye. The macula was edematous. Fundus fluoresce in angiography revealed perfusion only in peripapillary area suggestive of old retinal vessels occlusion, scattered retinal hemorrhages and venous tortuosity with macular edema bilaterally. This case reveals the occurrence of simultaneous bilateral central retinal vein occlusion and not associated with any systemic disease, it is rare and very challenging case not responding to any treatment with rapid progression inspite of immediate PRP and anti-VEGF injection.

Keywords: Central retinal vein occlusion, Macular edema, fundus fluorescence angiography.