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This patient's left visual acuity is 6/36 and there is no relative afferent pupillary defect. A repeated fluorescein angiogram shows macular oedema but without significant capillary non-perfusion. 

Is this patient still at risk of neovascularization?

Answer
While the physical signs and investigation suggest non-ischaemic
central retinal vein occlusion. A minority of initially well-perfused
eyes with CRVO will progress to retinal ischaemia with or without 
iris neovascularization within the first few months after the event.
The Central Vein Occlusion Study showed it happened to 16% 
of the patient. Therefore, initial monthly follow-up is recommended.
 

Is macular grid photocoagulation useful in improving this patient visual acuity?

Answer
The Central Vein Occlusion Study (CVOS) showed that macular grid 
photocoagulation does not improve the visual acuity in eyes with
macular oedema and visual acuity of 20/50 (=6/15) or worse. 
Although FFA showed reduction in the macular oedema following treatment.

 

What are the findings of Central Vein Occlusion Study with regard to prophylactic argon pan-retinal photocoagulation (PRP) in ischaemic central retinal vein occlusion?

Answer
The findings are:
PRP does not prevent iris or angle neovascularization
Regression of neovascularization is faster in untreated eyes.
 

Do you follow the Central Vein Occlusion Study with regard to panretinal photocoagulation for ischaemic retinal vein occlusion?

Answer
The findings of the study were rather controversial with regard to 
PRP for ischaemic CRVO. It is up to you to answer this question 
and provide the reasons (with reference to your hospital policy).
The recommendations of the CVO study are:
Careful observation with undilated slit lamp examination and 
gonioscopy.
Perform PRP only after neovascularization develops.
 
 
 

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