Current Ophthalmic Management for Retinal Vein Occlusion

Abstract

Retinal vein occlusion is associated with ocular morbidity and blindness as a result of macular oedema, macular ischaemia and neovascular glaucoma. New treatment options have become available, particularly for the management of the associated macula oedema; however, there is no consensus as to the best therapeutic option. ongoing trials will provide further evidence to aid decision-making as to the most cost-effective treatment option with the best visual outcome. We present a synopsis of the most recent trial data for the management of retinal vein occlusion. at present it is recommended that treatment choices are tailored to individual patient needs. KeywordsRetinal vein occlusion, ranibizumab, dexamethasone implant, aflibercept, laser Retinal vein occlusion (RVo) is a common retinal vascular disease second only to diabetic retinopathy, affecting the elderly population.1 Blockage of the retinal venous circulation has the potential to cause significant loss of vision. The introduction of newly approved anti-vascular endothelial growth factor (anti-VEGF) agents such as ranibizumab (lucentis; Novartis, Switzerland) and aflibercept (Eylea; Bayer, Germany), and the slow-release dexamethasone implant (ozurdex; allergan, uS) offer more treatment options to improve the potential for visual recovery. The remit of this article is to present a summary of the latest evidence on the ophthalmic management for RVo. Epidemiology and Pathophysiologya recent study on the prevalence of RVo has shown an age and sex standardised prevalence of 5.20 per 1,000 for any form of RVo.This was a large study of 68,751 individuals, ranging from 30 to 101 years of age. The prevalence of branch RVo (BRVo) was higher than central RVo (cRVo) (4.42 versus 0.80 per 1,000), increased with age and there was no difference between the sexes.2 over 50 % of cases of RVo occur in patients older than 65 years of age.3 it has also been shown that the chance of developing an RVo in the contralateral eye within 4 years of the first occlusion to be around 7 %.3 The exact pathogenesis of RVo still remains ill-defined. it is thought to occur due to a combination of venous stasis, degenerative changes of the vessel wall and blood hypercoagulability. This is known as Virchow's triad. The risk of RVo is higher in patients with hypertension, diabetes and hypercholesterolaemia.4 o'Mahoney et al. 4 performed a meta-analysis that showed that the prevalence of hypertension in RVo patients was 63.6 % compared with 36.2 % in controls. hyperlipidaemia was twice as common among patients with RVo (35.1 %) compared with controls (16.7 %). diabetes was slightly more prevalent among patients with RVo (14.6 %) than unaffected controls (11.1 %).Rarer associations include thrombophilia, 5 oral contraceptive pill, 6 optic disc vasculitis, 7 myeloproliferative 8 and systemic inflammatory disorders. 5Myeloproliferative disorders cause increased blood viscosity and systemic vasculitides, such as BehÇets and polyarteritis nodosa, cause retinal vasculitis leading to RVo, espec...