Purpose: An atypical case of a sectorial decompression retinopathy with branch retinal vein occlusion following trabeculectomy was reported and was diagnosed with optical coherence tomography angiography for which systemic genetic assessment revealed a MTHF-R mutation.
Method: Single case report.
Results: A 68-year-old woman diagnosed with an uncontrolled bilateral creeping angle glaucoma went through an uncomplicated trabeculectomy in both eyes. Best-corrected visual acuity was 20/20. Intraocular pressure changed from 28 mmHg preoperatively to 5 mmHG postoperatively in the right eye. On the first postoperative day, best-corrected visual acuity was 20/32 with intraocular pressure measured to 5 mmHg. Fundus examination revealed sectorial temporal hemorrhages with tortuous temporal superior retinal vein arcade and choroidal folds. Fluorescein angiography evidenced a slight delay in venous filling along the supratemporal arcade. Three months later, optical coherence tomography angiography showed macular capillary loops in the superotemporal area of the retina. This sectorial decompression retinopathy was evocative of a branch retinal vein occlusion. At 6 months, best-corrected visual acuity returned to 20/20, with full regression of the hemorrhages. Systemic workup was normal, but genetic assessment revealed a MTHF-R mutation.
Conclusion: Retinal vein occlusion can be considered as a feature of ocular decompression retinopathy. The present case is the first case to associate branch retinal vein occlusion secondary to ocular decompression retinopathy to a MTHF-R mutation.