Macular edema in Retinal vein occlusion
By Dr.Ahmed Saleh
Macular edema in vein occlusion
Is there any protocol to treat?
By Dr.Ameen Marashi :AntiVEGF monthly for 6 months then PRN for another 6 months with IOP monitoring.If you had a refractory edema then try Micropluse laser (Subthreshold diode Micropluse laser (the laser Ray is chopped to pulses so it won’t induce retinal burn and it fovea friendly))
Management of Central retinal vein occlusion:
- seek certain features that distinguish ischaemic from non-ischaemic CRVO. The former will be observed every 2 to 3 months ± treated with laser (panretinal photocoagulation) should any neovascularisation – particularly around the iris – occur.
- Reduction of intraocular pressure is needed if this is elevated.
- Intravitreal anti-VEGF agents:
- In combination with use of laser panretinal photocoagulation (PRP), should be used when iris new vessels or angle new vessels are visible.
- PRP results in dramatic regression of the new vessels. The effect is short-lived and new vessels recur commonly, so repeated treatment (typically every six weeks) with these agents (and PRP) may be required.
- Intravitreal aflibercept injection is recommended as an option for treating visual impairment caused by macular oedema secondary to CRVO.
- Intravitreal triamcinolone has been proposed as a treatment option for some of the associated complications (macular oedema and optic neuropathy) but has no proven effect on anterior neovascularisation.
- Intravitreal steroids have also been studied with regards to treating post-CRVO macular oedema. Currently, the response has been found to be positive but limited temporally and there are a number of complicating side-effects.
- Other experimental treatments are being investigated (particularly operative) but are still in early stages in their respective trials. Laser-induced chorioretinal venous anastomosis (L-CRA) has been used as a treatment for non-ischaemic CRVO. Where an anastomosis was successfully made, significant improvement was noted in visual acuity at 18 months after follow-up.
- Any underlying modifiable risk factors will need to be identified and addressed.