From the Guidelines
Retinal vein occlusion (RVO) in a young man requires prompt evaluation for underlying systemic conditions, and treatment should focus on both the underlying cause and ocular complications, with intravitreal anti-VEGF injections being first-line for macular edema. The most common causes in younger patients include thrombophilia (such as Factor V Leiden, protein C/S deficiency, antiphospholipid syndrome), hyperhomocysteinemia, inflammatory conditions (like Behçet's disease, sarcoidosis), hyperviscosity syndromes, and cardiovascular risk factors (hypertension, diabetes, hyperlipidemia) 1. Initial workup should include:
- Comprehensive medical history
- Complete blood count
- Lipid panel
- Fasting glucose
- Blood pressure measurement
- Thrombophilia screening
- Homocysteine levels
- Inflammatory markers (ESR, CRP)
- Cardiovascular assessment Imaging studies should include:
- Optical coherence tomography (OCT) to assess macular edema
- Fluorescein angiography to evaluate retinal circulation
- OCT angiography to assess vascular perfusion Systemic management includes treating identified risk factors with appropriate medications (antihypertensives, statins, anticoagulants if thrombophilia is present) 1. For ocular complications, intravitreal anti-VEGF injections (ranibizumab 0.5 mg, aflibercept 2 mg, or bevacizumab 1.25 mg) are first-line for macular edema, typically given monthly until resolution 1. Intravitreal steroid implants (dexamethasone 0.7 mg) may be considered for persistent edema. Laser photocoagulation is used for neovascularization or persistent macular edema. Regular follow-up is essential to monitor for complications like neovascular glaucoma. Prognosis depends on the extent of ischemia, presence of macular edema, and timely treatment initiation 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Causes of Retinal Vein Occlusion in Young Men
- Retinal vein occlusion (RVO) can be caused by various factors, including hyperviscosity syndrome, which may be associated with systemic conditions such as multiple myeloma 2
- In young adults, risk factors for central retinal vein occlusion (CRVO) include primary open-angle glaucoma (POAG), retinal vasculitis, pseudotumor cerebri, hypercoagulable state, history of deep vein thrombosis/pulmonary embolism (DVT/PE), and hyperlipidemia 3
Workup for Retinal Vein Occlusion
- Fluorescein angiography (FA) is essential for the diagnosis and prognosis of RVO, allowing recognition of the diverse types of RVO and detection of macular cystoid edema 4
- Optical coherence tomography angiography (OCTA) is a noninvasive imaging modality that allows for detailed en face visualization of the superficial and deep retinal vasculature separately 5, 6
- Spectral domain optical coherence tomography (SD-OCT) helps to quantify the changes in retinal thickness and supplies additional information, such as the presence and integrity of the outer limiting membrane and of the inner and outer segments of the photoreceptors 4
Treatment of Retinal Vein Occlusion
- Laser photocoagulation in a 'grid' pattern over the area demonstrated as leaking by FA remains the 'reference treatment for macular edema due to branch retinal vein occlusion' 4
- Intravitreal steroids and anti-VEGF drugs may temporarily reduce foveal edema and improve visual function 4
- Surgical treatment modalities, such as vitrectomy, may be considered in some cases, and the combination of surgery and intravitreal injection of steroids and/or an injection of tissue plasminogen activator could permit a more rapid and lasting action 4