From the Guidelines
The Royal College of Ophthalmologists guidelines for retinal vein occlusion recommend prompt referral to an ophthalmologist for diagnosis and management, with intravitreal anti-VEGF injections as the first-line treatment for branch retinal vein occlusion (BRVO) and central retinal vein occlusion (CRVO) with macular edema causing vision loss. For BRVO and CRVO, commonly used medications include ranibizumab (0.5mg), aflibercept (2mg), or bevacizumab (1.25mg), typically administered monthly for three initial doses, followed by as-needed injections based on disease activity, as supported by the CRUISE 1 and COPERNICUS 1 studies.
Key Treatment Considerations
- Intravitreal dexamethasone implant (0.7mg) is an alternative, especially for patients unresponsive to anti-VEGF therapy, with effects lasting 3-6 months.
- For ischemic CRVO, regular monitoring for neovascularization is essential, with panretinal photocoagulation recommended if it develops.
- Underlying systemic conditions like hypertension, diabetes, and hyperlipidemia should be identified and managed, as emphasized in the retinal vein occlusions preferred practice pattern® 1.
Management of Systemic Risk Factors
- Patients should be advised to control modifiable risk factors, including smoking cessation and maintaining optimal blood pressure.
- Regular follow-up appointments are crucial to monitor treatment response and disease progression, typically every 4-6 weeks initially, then adjusted based on clinical stability.
Goals of Treatment
- These guidelines aim to preserve vision by reducing macular edema and preventing complications like neovascular glaucoma, as highlighted in the study of comparative treatments for retinal vein occlusion 2 (SCORE2) 1.
From the Research
Royal College of Ophthalmologists (RCOphth) Guidelines for Retinal Vein Occlusion Management
The management of retinal vein occlusion (RVO) involves various treatment options, including intravitreal anti-vascular endothelial growth factor (VEGF) therapy, laser photocoagulation, and intravitreal corticosteroids. The Royal College of Ophthalmologists (RCOphth) guidelines for RVO management are based on the latest evidence from clinical trials and studies.
Treatment Options
- Intravitreal anti-VEGF therapy: This is the primary treatment for macular edema secondary to RVO, with agents such as ranibizumab, bevacizumab, and aflibercept showing significant improvement in visual acuity and reduction in macular edema 2, 3, 4, 5.
- Laser photocoagulation: This is used to treat ischemic retinal areas and prevent neovascularization, with grid or focal laser photocoagulation being effective in reducing the risk of visual loss 3, 4.
- Intravitreal corticosteroids: These are used as an alternative to anti-VEGF therapy, with dexamethasone implants showing stabilization of visual acuity in patients with macular edema secondary to RVO 2, 3, 5.
Treatment Regimens
- Pro-re-nata (PRN) regimen: This involves treating patients as needed, with intravitreal injections given based on clinical response and optical coherence tomography (OCT) findings 2.
- Treat-and-extend regimen: This involves treating patients with a fixed schedule of intravitreal injections, with the interval between injections extended based on clinical response and OCT findings 2.
Monitoring and Follow-up
- Regular monitoring with OCT and visual acuity assessments is essential to determine the need for retreatment and to adjust the treatment regimen as needed 2, 6, 4, 5.
- Fluorescein angiography is necessary to detect ischemic retinal areas and guide laser photocoagulation treatment 2.