This 78 year-old woman suffered from a right superior branch retina vein occlusion 4 month ago. The vision is now right 6/36 and left 6/9. Slit-lamp examination reveals bilateral early nuclear sclerosis and a macular oedema. Fluorescence angiography shows the above results.

When is the best time to carry out fluorescein angiography in a patient with branch retinal vein occlusion?

Answer
Ideally when there is spontaneous resolution of haemorrhages so that
the view of the fluorescein angiography is not occluded by retinal 
haemorrhages. This usually means a wait of 3 to 6 months.

Is it necessary to carry out fluorescein angiography in all cases of branch retinal vein occlusion?

Answer
No. If the branch retinal vein occlusion does not involve the macula
and the patient's vision is normal. Fluorescein angiography is of little benefit.

What features would you particularly look for in the fluorescence angiography in branch retinal vein occlusion?

Answer
The main purpose of performing fluorescein angiography is to look for
signs of treatable macular oedema. Signs favour successful treatment are absence of macular ischaemia and intact foveal vasculature.
The other feature to look is retinal ischaemia and this is defined as greater than 5 disc diameter of retinal capillary non-perfusion.
 

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