• Written By: Zaiba Malik, MD
    Comprehensive Ophthalmology

    This article presents an excellent review of the pathogenesis, risk factors, natural history, complications, diagnosis, and management strategies for retinal vein occlusion, but its focus is primarily on the different treatments available.

    Although grid laser has been the traditional first-line treatment for branch retinal vein occlusion (BRVO), data from recent high-quality randomized trials show some potential for intraocular glucocorticoids and anti-VEGF agents, which are increasingly used in clinical practice. Case series have suggested that intravitreal injection of triamcinolone acetonide may be useful for the treatment of macular edema in patients with BRVO, but a major study showed no visual improvement compared to controls, in addition to adverse events such as cataract progression and elevated IOP. Another large randomized study showed elevated IOP is also a common adverse effect of dexamethasone,  although dexamethasone showed good visual acuity results. Case series suggest the beneficial effects of ranibizumab and bevacizumab, and a large randomized trial showed good visual outcomes compared to controls with no significant difference in complications.

    For central retinal vein occlusion , anti-VEGF agents are widely used. Chorioretinal venous anastomosis has also been suggested; however, the potential benefits of this procedure, which uses laser therapy to create a bypass for the venous obstruction,  must be weighed against the risk of clinically significant ocular complications. Triamcinolone and dexamethasone have been evaluated as a potential treatment as well, but elevated IOP proved to be a significant adverse event for patients receiving these drugs.