Combined branch retinal vein and branch retinal artery occlusion – clinical features, systemic associations, and outcomes

Abstract

Purpose:Retinal vascular occlusions affecting both the arterial and venous systems are rare events. Combined branch retinal artery (BRAO) and vein (BRVO) occlusion are exceedingly rare and not well characterized.Methods:Six patients with combined BRAO and BRVO underwent a comprehensive eye examination, fundus fluorescein angiography, optical coherence tomography, and cardiovascular evaluation.Results:Mean age at presentation was 54 ± 7.8 years (range: 39–60), and five of the six were men. Patients had a combination of systemic comorbidities such as diabetes (5), hypertension (4), dyslipidemia (5), and hyperhomocysteinemia (1). All had unilateral combined occlusion characterized by narrowing and cattle tracking of blood in arteries and dilated tortuous veins in the involved quadrant. Fluorescein angiography demonstrated complete capillary drop out and a clear demarcation between the perfused and nonperfused retina. Presenting vision ranged from 6/9 to 1/60 Snellen's, and final vision depended on the macular perfusion status. All eyes were treated with angiography-guided sectoral laser photocoagulation, and three eyes required intravitreal bevacizumab due to macular edema or retinal neovascularization.Conclusions:Combined BRAO and BRVO is rare, may have unique underlying pathogenetic mechanisms, is associated with multiple systemic comorbidities and can yield good visual outcome if macula remains well perfused.

Retinal artery and vein occlusion in calciphylaxis

“…Combined BRVO and BRAO is not common and usually occurs in the presence of systemic diseases, including diabetes, dyslipidemia, systemic lupus, and hyperhomocysteinemia. 13 In this case of retinal artery and vein occlusion, the clinical presentation was consistent with systemic disease pathogenesis associated with calciphylaxis. The microangiopathy and vascular occlusion seen in calciphylaxis are due to progressive calcification of the media of blood vessels as well as fibrosis underneath the intima.…”

Foveal neovascularization in combined branch retinal vein and artery occlusion

“…CBRVAO is a retinal vascular disorder associated with severe systemic comorbidities that frequently complicates with retinal neovascularization generally growing at the optic disc or at the junction between the ischemic and the perfused retina. 6 …”

Role of Soluble Vascular Endothelial Growth Factor Receptor-1 and -2 in Regulating Branch Retinal Vein Occlusion with Macular Edema

“…These processes are all guided by inflammatory cytokines, chemokines and growth factors that control the behavior of lymphocytes, macrophages and bone marrow-derived endothelial progenitor cells (Khayat et al, 2018). The pathogenesis of macular edema in branch retinal vein occlusion is mediated by a variety of angiogenesis and inflammatory cytokines, especially vascular endothelial growth factor (VEGF) (Sengupta and Pan, 2017). Therefore, the pathogenesis and progression of branch retinal vein occlusion in patients with macular edema may be mediated by several intraocular angiogenesis and inflammatory mediators (Campagnoli et al, 2017).…”