(1)
St. Johns, FL, USA
(2)
Helen Keller Foundation for Research and Education, International Society of Ocular Trauma, Birmingham, AL, USA
(3)
Consultant and Vitreoretinal Surgeon, Milos Eye Hospital, Belgrade, Serbia
(4)
Consultant and Vitreoretinal Surgeon, Zagórskiego Eye Hospital, Cracow, Poland
58.1 General Considerations
A retinal vein is occluded by thrombus formation, occasionally by external compression, or due to a disease involving the vein wall (e.g., vasculitis).
58.1.1 Treatment Options
As a result of the occlusion, whether it involves a branch or the central retinal vein, the retina in the affected area becomes hemorrhagic and edematous. The loss of vision may be the result of the VH, the macular edema, the accompanying ischemia, and/or consequent neovascularization; TRD may also occur. The new vessels can be present both in the retina and the anterior segment; the latter may lead to the development of neovascular glaucoma, which is another potential source of visual loss.
There are numerous treatment modalities ranging from observation1 to grid and/or panretinal laser, intravitreal injections,2 and implants to radial optic neurotomy, as well as vitrectomy. Table 58.1 provides a few thoughts on the different treatment modalities. The technique described below reflects my typical approach; the other treatment options are not discussed in this book.
Table 58.1
Treatment options in RVO
|
Treatment modality |
Comment |
|---|---|
|
Laser, grid/sectoral |
Better than observation in eyes with BRVO |
|
Laser, panretinal |
Somewhat effective in preventing neovascular glaucoma |
|
Intravitreal steroid,injection/implant |
Effective, but only on a temporary basis, in treating macular edema |
|
Anti-VEGF, injection |
Effective, but only on a temporary basis, in treating macular edema |
|
Radial optic neurotomy
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