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	Colour Fundus Photo 3 month later

Clinically:

• Macular Haemorrhage
• Macular Oedema
• Macular Non Perfusion
• Subhyaloid haemorrhage
• Vitreous haemorrhage

Ophthalmoscopy:

• Retinal Haemorrhages superficial & deep in all retinal quadrants
• Prominent venous dilatation and tortousity along all the venous tree
• Areas of retinal oedema
• Areas of soft exudate corresponding to nerve fiber layer necrosis
• Subhyaloid hges
• Vitreous hge

Prognosis

• Depends on the state of retinal perfusion whether



Ischaemic [profound non perfusion]	Non-Ischaemic Haemorrhagic [Good Perfusion]

Possibly complicating Ischaemic Type:
Still there are viable retinal tissues responsible for production of the vasoformative factor responsible for Neovascularization
 

• Absorption of Retinal Haemorrhages within "3-18 month"
• Although fluorescein angiography is a good diagnostic tool, still it cannot distinguish:

The Ischaemic Viable	The Ischaemic Non Viable

• ERG is of very important Functional Evaluation tool

A Wave	B Wave
It reflects Photoreceptor Function	It reflects Inner Nuclear Layer "Muller's Cell" Function
It receives blood supply from Choroidal circulation	It receives blood supply from Central Retinal Artery

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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 & unhealthy blood vessels.
• Areas of collateral vessel formation
• Areas of NVD & NVE leak more prominant than collaterals

• Macular Oedema with cystoid changes
• State of Retinal Perfusion. It is of very important prognostic and therapeutic value.One has to take serial photos to the mid periphery of the retina, being the very sensitive area responsible for possibly vasoformative factor inducing neovascularization

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

Marked Visual Deterioration

Less Marked Visual Deterioration

Evaluate the state of Retinal Non Perfusion "If more than 10 DD" Evaluate the state of Reinal Tissue Viability "ERG"   Non Viable Viable Burnt Out Retina Non Burnt Out Retina Less possible to complicate More Likely to complicate NVD / NVE Neovascular Glaucoma "Gonio examination without dilatation"

Evaluate Retinal Perfusion after 6 months 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 CRV 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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