case_images: PMC6050648_01
case_images: Color fundus photograph of the left eye of a 35 year-old male with cystic fibrosis and inferior branch retinal vein occlusion. Notable flame hemorrhages along the inferior nerve fiber layer with marked arteriovenous nicking and minimal macular edema. Arteriovenous nicking is present along both the superior and inferior arcades which corresponds to the patient's known systemic hypertension
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case_images: PMC6050648_01_40942_2018_129_Fig1_HTML.jpg
case_images: Fig1
case_images: His anterior exam was unremarkable, but his posterior exam in the left eye was significant for intraretinal hemorrhages along the nerve fiber layer with associated retinal thickening in the inferior macula consistent with a BRVO (Fig. 1). The only significantly abnormal lab was a fibrinogen level of 479 mg/dL (200-375 mg/dL).The patient was observed without treatment given his visual acuity was 20/20 and the macular fluid did not involve the fovea (Fig. 1).
case_images: Optical coherence tomography of the left eye with intraretinal cystic fluid near the fovea. There is trace subfoveal fluid with a small amount of hyper-reflective material directly beneath and inferior to the fovea
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case_images: Fig2
case_images: Optical coherence tomography revealed mild intraretinal and trace subfoveal fluid in the left eye (Fig. 2).
case_images: Early (left) and late (right) fluorescein angiogram (FA) of the left eye with delayed venous filling inferiorly during the early peak phase with a small area of blocking inferior to the disc corresponding to hemorrhage on exam (left). Telangiectatic vessels are noted in the early phase FA as well. In the late phase FA, there is leakage inferiorly along the arcade at areas of AV nicking. Also seen during the late phase FA is leakage at the inferior edge of the fovea corresponding to the intraretinal fluid seen on OCT (right)
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case_images: PMC6050648_01_40942_2018_129_Fig3_HTML.jpg
case_images: Fig3
case_images: The findings were confirmed with fluorescein angiogram which revealed delayed venous filling in the inferior venous arcade (Fig. 3).   
case_images: Optical coherence tomography of the left eye 6 months after initial presentation with resolution of the intraretinal and subretinal near the fovea. The foveal contour and photoreceptor layers remain intact
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case_images: Fig4
case_images: Six months after presentation he remained 20/20 in both eyes and the macular fluid had resolved (Fig. 4) with careful observation.