Concurrent vs dependent retinal arteriolar occlusion and central vein occlusion

Sir,

Ozdek et al¹ report details of two patients with hyperhomocysteinaemia who presented with nonischaemic occlusion of the central retinal vein (CRV) and putative concurrent occlusion of a branch retinal arteriole. They make reference to an earlier description of seven eyes similarly affected by CRV occlusion and segmental inner retinal infarction² in which cilioretinal infarction, secondary to the CRV occlusion,^{3, 4} was discounted as the mechanism of ischaemia. However, a single vascular luminal obstruction is more likely than two simultaneous (but separate) occlusions, especially in young patients. The possibility of cilioretinal infarction should be seriously entertained, therefore, even if this implies that up to half of the retinal circulation must perforce derive from posterior ciliary branches of the ophthalmic artery. Indeed, in Case 1 of this latest report,¹ the inferotemporal vessel supplying the territory of the infarct appears to have a ‘hook’ characteristic of a cilioretinal arteriole as it emerges from the disc rim.

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