Areas of Block fluorescence corresponding to hges  Areas of hypofluorescence corresponding to areas of capillary non perfusion  Areas of hyperfuorescence corresponding to leakage from affected vascular tree	Areas of Block fluorescence corresponding to hges  Tortuous dilated Lower temporal vein

Clinically:

• Sudden painless recurrent attacks of blurred vision
• Sudden painless recurrent attacks of visual field defects
• Sudden painless deterioration of vision due to:
1. Macular Haemorrhage
2. Macular Oedema
3. Macular Non Perfusion
4. Subhyaloid haemorrhage
5. Vitreous haemorrhage

Ophthalmoscopy:

• Segmental intra Retinal Haemorrhages in one or two quadrants according to site of occlusion
• Prominent venous dilatation and tortousity along the affected vessels
• Areas of retinal oedema along the affected vessel

Prognosis

• Nearly complete resolution within one year unless complications occur.
• Absorption of Retinal Haemorrhages within "3-18 month"

Fluorescein Angiography Evaluation:
FFA demonstrates:
Segmental distribution of Retinal Vascular Abnormalities including:

• Areas of Block Fluorescence corresponding to areas of Haemorrhages
• Areas of Hypofluorescence corresponding to areas of Capillary Non Perfusion
• Areas of hyperfuorescence corresponding to  areas of micro aneurysms
• Areas of collateral vessel formation
• Areas of NVD & NVE

• Macular Oedema with cystoid changes
• State of Retinal Perfusion. It is of very important prognostic and therapeutic value.

Management:
Follow up for "3-4 month" till retinal/ Subhyaloid/Vitreous haemorrhages absorb
Re Evaluate the condition:
Visual Acuity
 

Improves

Drops or vision does not improve > 6/12 with best correction

Keep Follow up NVD / NVE Neovascular Glaucoma "Gonio examination without dilatation"

Evaluate the aetiology FFA   Persistent Macular Oedema with Cystoid Formation Capillary Non Perfusion involving FAZ Grid Photo Coagulation Nothing help Follow "3-4 m" FFA to evaluate state of macula    oedema Improves oedema persists Keep Follow Retreat Grid Area Of capillary Non Perfusion > 5 DD Start PRP to avoid Neovascular Glaucoma Keep Follow for: NVD / NVE Neovascular Glaucoma "Gonio examination without dilatation"    Prophylactic Mild Scatter PRP may and may not be  Better Follow/4m or apply if NVD or NVE appears

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Grid Photocoagulation For Macular Oedema In Branch Vein Occlusion:
Argon Laser :
Spot size: 100 um
Duration:  100 msec
Power   :  Sufficient to produce minimum bleach
Roles:

• Two rows land marking temporal edge of Macula "Capillary Free Zone - Never approximate more"
• Extend all over but not > the vascular arcades
• Repeated/Week staged settings = Single setting

• If area of capillary non perfusion > 5DD
• If NVD or NVE appear during per month follow up

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