By the American Academy of Ophthalmology Preferred Practice Pattern Retina/Vitreous Panel: Jose S. Pulido, MD, MS, MPH,1 Christina J. Flaxel, MD,2 Ron A. Adelman, MD, MPH, MBA,3 Leslie Hyman, PhD,4 James C. Folk, MD,5 Timothy W. Olsen, MD6
As of November 2015, the PPPs are initially published online-only in the Ophthalmology journal and may be freely downloaded in their entirety by all visitors. Open the PDF for this entire PPP or click here to access the journal's PPP Collection page.
1 Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota
2 Casey Eye Institute, Oregon Health & Science University, Portland, Oregon
3 Department of Ophthalmology and Visual Science, Yale School of Medicine, New Haven, Connecticut
4 Division of Epidemiology, Department of Family, Population and Preventive Medicine, School of Medicine, Stony Brook University, Stony Brook, New York
5 Department of Ophthalmology and Visual Sciences, University of Iowa Hospitals & Clinics, Iowa City, Iowa
6 Emory Eye Center, Emory University, Atlanta, Georgia
HIGHLIGHTED FINDINGS AND RECOMMENDATIONS FOR CARE
The prognosis of retinal vein occlusions (RVOs) varies according to the site of the occlusion and the degree 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 behave similarly. They are often associated with glaucoma and have a higher risk of anterior segment neovascularization and neovascular glaucoma. Branch retinal vein occlusions (BRVOs) and hemiretinal vein occlusions ([HRVOs], which are distinct from hemi-CRVOs) have a visible arterial-venous crossing where the occlusion occurs. They are more commonly associated with systemic hypertension, diabetes, and lipid disorders, and they are more likely to lead to retinal neovascularization.
Macular edema may complicate both CRVOs and BRVOs. The safest treatment for the associated macular edema is the use of antivascular endothelial growth factors (anti-VEGFs). Intravitreal corticosteroids, with the associated risk of glaucoma and cataract formation, have demonstrated efficacy. Also, laser photocoagulation in BRVO has a potential role in treatment.
Risk factors for vein occlusions include systemic medical conditions, such as systemic arterial hypertension, diabetes, and lipid and coagulation disorders. Thus, communication with the patient’s primary care provider to help coordinate care is important.
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.