Abstract
Retinal periphlebitis is a subtype of retinal vasculitis affecting the retinal
veins. We report a case of bilateral branch retinal vein occlusion (BRVO)
associated with idiopathic retinal periphlebitis and complicated by subfoveal
hemorrhage (SFH). An 18-year-old woman presented with best-corrected visual
acuity of 20/20 in the right eye and 20/30 in the left eye. Examination revealed
bilateral retinal vascular sheathing predominantly involving the retinal veins
and bilateral BRVO. Fundus fluorescein angiography revealed localized vascular
leakage in the right eye and diffuse vascular leakage in the left eye.
Spectral-domain optical coherence tomography showed mild nasal thickening with
subfoveal fluid in the left eye. Oral steroids were started on a tapering dosage
as well as oral methotrexate. A year later, she presented with regressed
vascular sheathing in both eyes with 5/200 vision and SFH in the left eye. Pars
plana vitrectomy, subretinal tissue plasminogen activator, intravitreal
ranibizumab, laser photocoagulation, and gas injection were performed. The SFH
resolved and the visual acuity improved to 20/100. Good vision was preserved in
both eyes with no active inflammation. Timely management of SFH in idiopathic
retinal periphlebitis can achieve a favorable visual outcome.