By the American Academy of Ophthalmology Preferred Practice Pattern Retina/Vitreous Committee: Christina J. Flaxel, MD,1 Steven T. Bailey, MD,2 Jennifer I. Lim, MD,3 Ron A. Adelman, MD, MPH, MBA, FACS,4 Amani Fawzi, MD,5 G. Atma Vemulakonda, MD,6 Gui-shuang Ying, MD, PhD7
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1Casey Eye Institute, Oregon Health & Science University, Portland, OR
2Casey Eye Institute, Oregon Health & Science University, Portland, OR
3University of Illinois at Chicago, Chicago, IL
4Yale University Eye Center, New Haven, CT
5Feinberg School of Medicine, Northwestern University, Chicago, IL
6Department of Ophthalmology, Palo Alto Medical Foundation, Palo Alto, CA
7Center for Preventative Ophthalmology and Biostatistics, Department of Ophthalmology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
Highlighted Findings and Recommendations for Care
The prognosis of retinal vein occlusions (RVOs) varies according to the site of the occlusion and the type of occlusion (ischemic or nonischemic). In general, more-distal RVOs with less occlusion have a better prognosis than more-proximal RVOs with greater ischemia.
Central retinal vein occlusions (CRVOs) and hemi-CRVOs have clinically similar courses. They are associated with glaucoma and have a higher risk of anterior segment neovascularization and neovascular glaucoma. Branch retinal vein occlusions (BRVOs) and hemiretinal vein occlusions have a visible arterial-venous crossing where the occlusion occurs.
Macular edema may complicate both CRVOs and BRVOs. The first line of treatment for associated macular edema is anti-vascular endothelial growth factors (anti-VEGFs). Intravitreal corticosteroids, with the associated risk of glaucoma and cataract formation, have demonstrated efficacy. Also, laser photocoagulation surgery in BRVO has a potential role in treatment.
Optimizing control of systemic arterial hypertension, diabetes, serum lipid levels, and intraocular pressure (IOP) to control glaucoma are all important in the management of systemic risk factors, as is communicating end-organ damage to the primary care provider.