Central retinal vein occlusion with exudative retinal detachment and neovascular glaucoma The patient was a 42-year-old female. She was admitted to the hospital on January 5, 2009, with “4 months of blurred vision in the right eye, aggravated for 2 months”. In September 2008, the patient had no obvious cause for the onset of blurred vision in the right eye, accompanied by eye redness, eye pain and tearing, with no history of ocular trauma; in November 2008, she felt that her blurred vision had worsened significantly, with no history of ocular trauma. He had suffered from hypertension for 5 years and had no history of other systemic diseases. Specialized examination: visual acuity: inaccurate visual perception in the right eye, 1.0 in the left eye; intraocular pressure: 34 mmHg in the right eye, 12 mmHg in the left eye; conjunctival congestion in the right eye, corneal transparency, deep anterior chamber, KP (-), atrial flash (-), neovascularization visible on the iris surface, post-iris adhesions on the nasal side and part of the iris below, pupil not round, about 6 mm in diameter. Loss of light response, pigmentation visible on the surface of the lens, punctate clouding of the posterior capsule of the lens (Figure 1), vitreous clouding (++++), and invisibility of the fundus. No abnormalities were seen in the left eye. Auxiliary examinations: ocular A/B ultrasound showed: eye axis 22.6mm in the right eye and 22.8mm in the left eye; retinal detachment, optic disc depression and vitreous opacity in the right eye (Figure 2); visual electrophysiology: ERG and Ops were not elicited in the right eye, and F-VEPP1 wave amplitude was low. Preliminary diagnosis: retinal detachment with neovascular glaucoma in the right eye, cataract in the right eye, and old iridocyclitis in the right eye. On 2009-01-19, “vitrectomy and lens resection combined with silicone oil filling of the right eye” was performed under local anesthesia and reinforcement. A large amount of subretinal fluid was seen, and yellowish-white crystalline particles were seen between them. Postoperative fundus fluorescein angiography (Figure 3 and Figure 4) showed extensive capillary non-perfusion areas in the retina of the right eye, fluorescence leakage from the still preserved capillaries in the retina and capillaries in the optic disc, and retinal vascular dilatation, and the diagnosis: ischemic central retinal vein obstruction in the right eye. On the third postoperative day, the visual acuity of the right eye was manual/in front of the eye, the intraocular pressure was 21 mmHg, and the retina was well reset. Discussion: Patients with CRVO complicated by exudative retinal detachment are relatively rare. A retrospective study showed its relative incidence to be 0.63% [1]. According to Peng et al, by 2005, the total number of patients with exudative retinal detachment caused by CRVO was less than 20 [2], and it has not been reported in China except for 15 cases reported by Peng et al. Exudative retinal detachment can be seen after branch retinal, hemiportal and central vein obstruction. Macular edema occurring after retinal vein obstruction and exudative retinal detachment after macular grating-like photocoagulation has also been reported [3]. Patients with CRVO complicated by exudative retinal detachment most often present with complaints of vision loss and are seen 1-7 months from the time of onset. Iris neovascularization with elevated IOP, retinal hemorrhage, tortuous and dilated retinal veins, and extensive yellow-white retinal exudate are seen in approximately 33% of patients. Retinal detachment had significant somatic mobility. Fluorescein fundus angiography revealed scattered areas of capillary nonperfusion, and large areas of nonperfusion located in the posterior pole were more pronounced. There were varying degrees of wall staining and leakage in the retinal vessels. Neovascularization of the optic papilla may be present [2]. The disease has the following clinical features: (1) it is characterized by subretinal fluid mobility; (2) the age of onset is significantly lower than in the general population of CRVO, and some patients have abnormal blood rheology; (3) the fundus changes, in addition to the general CRVO features, are characterized by the following features, namely, tortuous and unremarkable retinal veins; marked hemorrhage in the macula; and extensive subretinal exudates. Vascular anastomosing branches of the optic papilla are rare; (4) the aperfusion zone of the retinal vessels is more pronounced in the posterior pole compared to the general CRVO patients [2]. The cause of exudative retinal detachment in patients with retinal vein obstruction is unclear; Ravalico et al. speculated that in these patients there may be both retinal capillary occlusion and retinal pigment epithelial pump dysfunction, resulting in obstruction of the outflow of intraocular fluid [1]; Battaglia et al. suggested that the cause may be related to insufficient establishment of retinal collateral circulation and retinal ischemia resulting in retinal pigment Battaglia et al. [4] suggested that the cause may be related to insufficient establishment of retinal collateral circulation and retinal pigment epithelial damage due to retinal ischemia [4]; in addition, the lack of effective optic papillary anastomotic branch formation may also be a risk factor [5, 6]; Peng et al. [2] found that patients mostly had abnormal blood components and/or combined inflammatory reactions, suggesting that the abnormal blood components and their leakage from the vessel wall into the retinal interlayer may not only be the cause of disruption of retinal pigment epithelial pump function, but may also lead to an increase in the protein content of the subretinal fluid, causing significant mobility changes in the subretinal fluid. The main causes of low visual function are high edema of the macula, large hemorrhages and neovascular glaucoma. In addition, persistent retinal detachment can also affect the pigment epithelial function of the macula, further aggravating the visual impairment. It is clear that CRVO with exudative retinal detachment is a serious complication that impairs the visual function of patients and must be taken seriously by ophthalmologists. Weinberg reported complete or partial absorption of subretinal fluid after retinal photocoagulation in 4 of 5 eyes, but the visual prognosis was poor in all cases [5]. parodi concluded that macular grid-like photocoagulation was effective in stopping visual loss in patients with ischemic retinal branch vein occlusion complicated by exudative retinal detachment after 24 months of follow-up [7]. In our patient, the preoperative diagnosis of exudative retinal detachment was not based on a sufficient basis because of the complete and prolonged retinal detachment, retinal thickening and stiffness, so that the mobility of the subretinal fluid was not clearly characterized, and there was clouding of the crystal and posterior capsule, vitreous clouding, and the fundus could not be seen. In patients with fundus visible CRVO and retinal detachment, the possibility of exudative retinal detachment should be considered and retinal laser photocoagulation may be effective; however, in patients like the present case, the fundus is not visible and neovascularization has occurred in the iris, so there is no possibility of laser photocoagulation, and early surgery may prevent neovascular glaucoma and vitreous hemorrhage.