Tests
1st tests to order
fluorescein angiogram for confirmation of diagnosis
Test
Occurs in affected region of retina: all major veins in central retinal vein occlusion (CRVO), 1 major or secondary vein in branch retinal vein occlusion (BRVO), superonasal and superotemporal branches or inferonasal and inferotemporal branches in hemiretinal vein occlusion (HRVO).
Areas of blocked fluorescence occur in regions of intraretinal hemorrhage, which are present only in area affected by RVO.[Figure caption and citation for the preceding image starts]: Color photograph, left eye; branch retinal vein occlusion; multiple intraretinal images in quadrant of blocked veinFrom the personal library of Dr Aziz Khanifar [Citation ends].
[Figure caption and citation for the preceding image starts]: Fluorescein angiogram, right eye; central retinal vein occlusion; delayed drainage of veins in each quadrantFrom the personal library of Dr Aziz Khanifar [Citation ends].
Result
delayed venous filling during transit phase; areas of blocked fluorescence
Tests to consider
fluorescein angiogram for assessment of complications
Test
Areas of nonperfusion suggest significant ischemia. In CRVO, the presence of 10 disk areas of nonperfusion suggests that the RVO is "ischemic." In BRVO, the presence of 5 disk areas of nonperfusion suggests that the RVO is "nonperfused."
Petalloid parafoveal leakage suggests cystoid macular edema. Can also emanate from collateral vessels in BRVO.
Areas of neovascularization have significant leakage.
Result
areas of nonperfusion; petalloid parafoveal leakage; leakage from retinal neovascular complex
optical coherence tomography
Test
Confirms presence of macular edema.
May reveal intraretinal hyporeflectivity and thickening of the neurosensory retina (evidence of cystoid macular edema). Subretinal hyporeflectivity (evidence of subretinal fluid) can be found in eyes with large amounts of macular edema. Can be quantified in microns (retinal thickness) or as cubic millimeters (total macular volume). Can be used to evaluate response to therapy for macular edema. Macular edema will be present asymmetrically in a BRVO. For example, for a superior BRVO, only the superior half of the macula will be edematous.[Figure caption and citation for the preceding image starts]: Fluorescein angiogram, left eye; branch retinal vein occlusion; delayed drainage of blocked vein superotemporallyFrom the personal library of Dr Aziz Khanifar [Citation ends].
Result
cystoid retinal thickening in macular edema
electroretinography
Test
Can confirm perfusion status of CRVO (especially in setting of vitreous hemorrhage or significant intraretinal hemorrhage that prohibits utility of fluorescein angiogram).[25]
Very infrequently used in routine clinical practice.
Result
mean b-wave amplitude reduced by ≥40%
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