From the Guidelines
The primary treatment for Central Retinal Vein Occlusion (CRVO) is anti-VEGF agents, such as ranibizumab, aflibercept, or bevacizumab, which have been shown to be effective in treating macular edema associated with CRVO 1.
Key Points
- Anti-VEGF agents: Ranibizumab, aflibercept, and bevacizumab have been shown to be effective in treating macular edema associated with CRVO, with significant improvements in visual acuity and reduction in macular edema 1.
- Intravitreal corticosteroids: Triamcinolone, dexamethasone, and other corticosteroids have also been shown to be efficacious for macular edema associated with CRVO, but are associated with risks of cataracts and glaucoma 1.
- Laser photocoagulation: While laser photocoagulation has been used to treat macular edema associated with CRVO, anti-VEGF agents have been shown to result in more improvement in visual acuity and are generally preferred unless there are contraindications to their use 1.
Treatment Approach
The treatment approach for CRVO typically involves:
- Initial treatment: Anti-VEGF agents, such as ranibizumab or aflibercept, are commonly used as initial treatment for macular edema associated with CRVO 1.
- Follow-up: Patients are typically followed up regularly to monitor the response to treatment and adjust the treatment plan as needed 1.
- Rescue therapy: Intravitreal corticosteroids, such as dexamethasone, may be used as rescue therapy for patients who do not respond to anti-VEGF agents 1.
From the Research
Treatment Options for Central Retinal Vein Occlusion (CRVO)
The treatment for CRVO can be subdivided into several categories, including:
- Systemic use of anticoagulation drugs 2
- Local treatments, such as:
- Intravitreal pharmacotherapy, including the use of steroids 6, 4
- Sustained drug delivery devices 4
Treatment Outcomes
Studies have shown that treatment with anti-VEGF can lead to significant improvements in visual acuity and central macular thickness in patients with CRVO 5, 6. However, the long-term outcomes can vary, with some patients experiencing a complete response to treatment and others showing partial or no response 6.
Treatment Protocols
Different treatment protocols have been proposed, including a pro re nata (PRN) protocol, which involves treating patients as needed, rather than on a fixed schedule 6. This approach has been shown to be effective in improving vision and maintaining gains over long-term follow-ups.
Surgical Treatment
Surgical treatment of CRVO is still a subject of debate, but it can be an option for patients who do not respond to other treatments 3. The outcomes of surgical treatment strategies have been summarized in several reviews, and different opinions on the various surgical approaches have been discussed 3.