OSLI Retina

June 2020

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June 2020 ยท Vol. 51, No. 6 321 OCT images to be associated with poor visual prog- nosis. In our retina clinic, we found a few cases of acute BRVO presenting with hyperreflective ma- terial (HRM), either intraretinal or subretinal, and having variable visual outcomes. Similarly, pres- ence of intraretinal HRM has been described in dia- betic macular edema (DME) as solid-appearing reti- nal cysts by Liang et al. 18 The authors hypothesized that these intraretinal HRMs are mainly composed of fibrin or other inflammatory end products. HRM, underneath either the retina or retinal pigment epi- thelium, has been described in cases with neovas- cular age-related macular degeneration (AMD). The presence of central and thick subretinal HRMs with well-defined borders were associated with poorer visual prognosis in eyes with neovascular AMD. 19 To the best of our knowledge, there is no published literature on acute BRVO studying the presence and etiopathogenesis of HRM and correlating its pres- ence with the final VA. With this background, we aimed to study the etiopathogenesis, clinical profile, OCT imaging fea- tures, and VA changes in eyes of acute BRVO with or without the presence of HRM. PATIENTS AND METHODS For this retrospective cohort study, all data were collected and analyzed in accordance with the Figure 1. Acute branch retinal vein occlusion (BRVO) with intraretinal hyperreflective material: pre- and post-treatment outcomes. (A, B) A 55-year-old female presenting with right eye acute inferotemporal BRVO. Her presenting visual acuity (VA) was 20/120 (0.78 logMAR). Optical coherence tomography image at presentation showed presence of spongiform macular edema with cystoid changes. A clump of hyperreflective material was noted within the intraretinal cyst (white arrow). The external limiting membrane layer and ellipsoid zone (EZ) was continuous. Following three injections of intravitreal anti-vascular endothelial growth factor (bevacizumab), complete resolution of the macular edema was noted with resolution of the intraretinal hyperreflective material. The external limiting membrane and EZ layers were intact following treatment. Her VA improved to 20/80 (0.60 logMAR) at the final follow-up visit.

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