Retinal vein occlusion: Treatment
- Douglas J Covert, MD, MPH
Douglas J Covert, MD, MPH
- Associated Retinal Consultants
- Traverse City, MI
- Dennis P Han, MD
Dennis P Han, MD
- Jack A. and Elaine D. Klieger Professor of Ophthalmology Director
- Vitreoretinal Section Medical College of Wisconsin
Retinal vein occlusion (RVO) is an important cause of visual loss among older adults throughout the world . RVO is the second most common cause of vision loss from retinal vascular disease, following diabetic retinopathy . Despite many proposed interventions, there are no treatments proven to reopen occluded retinal veins. Management is directed at secondary complications of RVO that affect vision, including macular edema, retinal neovascularization, and anterior segment neovascularization. Effective treatment for macular capillary nonperfusion, a fourth cause of visual loss in RVO, is not available.
Treatment modalities, including medical therapies, laser photocoagulation, and other surgical therapies, will be discussed here. Epidemiology, pathophysiology, clinical manifestations, and diagnosis of RVO are discussed separately. (See "Retinal vein occlusion: Epidemiology, clinical manifestations, and diagnosis".)
Overview — There are two major anatomic types of retinal vein occlusion (RVO): branch retinal vein occlusion (BRVO) and central retinal vein occlusion (CRVO). BRVO occurs when a vein in the distal retinal venous system is occluded, leading to hemorrhage along the distribution of a small vessel of the retina. CRVO occurs due to thrombus within the central retinal vein at the level of the lamina cribrosa of the optic nerve, leading to involvement of the entire retina. Less commonly, hemiretinal vein occlusion may occur when there is blockage of a vein draining the superior or inferior hemiretina. (See "Retinal vein occlusion: Epidemiology, clinical manifestations, and diagnosis", section on 'Classification'.)
Newly diagnosed patients with ischemic CRVO can be categorized by their degree of visual loss and findings on examination:
●Severe visual loss – In patients with severe visual loss (eg, 20/400 visual acuity or less), relative afferent pupillary defect (eg, greater than 1 log unit as tested with neutral density filters), diffuse retinal hemorrhage (often representing indeterminate perfusion status), or retinal capillary nonperfusion (eg, greater than 10 disk areas by fluorescein angiography), monthly examinations for six to eight months after initial diagnosis is advised in order to detect development of retinal or anterior segment neovascularization. If there is progression of visual decline or increasing hemorrhage, monthly examinations should be extended until stability can be established for at least six to eight months.To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
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- Macular edema
- Retinal neovascularization
- Anterior segment neovascularization
- MEDICAL THERAPY
- Vascular endothelial growth factor inhibitors
- - Evidence of effectiveness for BRVO
- - Evidence of effectiveness for CRVO
- Intravitreal glucocorticoids
- - Effectiveness of intravitreal injection of triamcinolone
- - Effectiveness of glucocorticoid implant
- Antithrombotic and thrombolytic therapy
- RETINAL LASER PHOTOCOAGULATION
- SUMMARY AND RECOMMENDATIONS