1 Worldwide, it is estimated that 16.4 million people have had an RVo (5.2 per 1,000 persons), 13.9 million with BRVo (4.42 per 1,000 persons), and 2.5 million with cRVo (0.80 per 1,000 persons).There is a higher prevalence of BRVo in asians and hispanics than in other ethnic groups. 2 RVo typically occurs in the middle aged to elderly group (more than 50 years), with an equal gender distribution. While there are many similarities between BRVo and cRVo, there are also important differences. This review focuses on BRVo.
Risk Factorshypertension is a major risk factor for BRVo.
AbstractBranch retinal vein occlusion (BRVo) is a relatively prevalent cause of reduced vision primarily due to macular edema. Vascular endothelial growth factor (VEGF) is the major stimulator of excessive vascular leakage and also contributes to retinal hemorrhages and progressive retinal nonperfusion (RNP). Progressive RNP results in worsening of retinal ischemia further increasing levels of VEGF, resulting in a positive feedback loop for disease worsening over time. aggressive early treatment with a specific antagonist of VEGF causes rapid improvement in edema and visual acuity, speeds resolution of hemorrhages, and stabilizes or improves RNP. Therefore, first-line treatment of acute BRVos is monthly injections of an anti-VEGF agent for at least 6 months. after that, a period of monthly follow up with anti-VEGF treatment, only if there is recurrent edema, can be used to gauge persistent disease activity and the need for grid laser photocoagulation to diffuse leakage in the macula outside the foveal avascular zone. Following grid laser, another period of monthly follow up with anti-VEGF treatment only if there is recurrent edema provides a measure of persistent disease activity, and if frequent injections are still needed to control edema, the benefits and risks for switching to dexamethasone implants should be discussed with the patient.
Keywords hypoxia, retinal ischemia, vascular leakage, vascular endothelial growth factorDisclosure: Raafay Sophie, Md, has no conflicts of interest to declare. Peter a campochiaro, Md, is a consultant for Kala Pharmaceuticals and applied Genetic Technologies corporation and served as a consultant for allergan within the past 2 years. he has equity in GrayBug, inc. Johns hopkins university receives payment for his consultation with Genentech, Regeneron, and aerpio. he receives research support from Genentech, Regeneron, allergan, aerpio, Genzyme, and oxford BioMedica. These activities are being managed by the conflict of interest committee of the Johns hopkins university School of Medicine.