Retinal Vein Occlusion and Low-Dose Fibrinolytic Therapy (R.O.L.F.)

Hattenbach, Lars‐Olof; Arndt, Carl; Lerche, R.-C.; Scharrer, I.; Baatz, H.; Margaron, F.; Richard, Gisbert; Behrens–Baumann, W.; Ohrloff, C.

doi:10.1097/iae.0b013e3181a3b870

Cited by 34 publications

(5 citation statements)

References 39 publications

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“…But there was no conclusive evidence for BRVO. Another interesting observation of this study was that thrombolysis was not associated with a lower risk of ocular neovascularization, indicating that the mechanisms involved in this process occur at an early stage [15]. Besides, Hayreh’s [16] experience indicates that anticoagulants and antiplatelet agents are also contraindicated in CRVO, as they are not only of no therapeutic value but can be harmful.…”

Section: Treatmentmentioning

confidence: 99%

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Retinal Vein Occlusion: Current Treatment

Lattanzio¹,

Gimeno

Parodi³

et al. 2010

Ophthalmologica

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Retinal vein occlusion (RVO) is a pathology noted for more than 150 years. Although a lot has been written on the matter, it is still a frequent condition with multifactorial etiopathogenesis with many unclear aspects. The RVO pathogenesis has varied systemic and local implications that make it difficult to elaborate treatment guidelines. The management of the patient with RVO is very complex and a multidisciplinary approach is required in order to identify and correct the associated risk factors. Laser therapy remains the gold standard in RVO, but only modest functional improvement has been shown in branch retinal occlusion forms. Multicenter studies of intravitreal drugs present them as an option to combine with laser. Anti-vascular endothelial growth factor, corticosteroids and sustained-release implants are the future weapons to stop disease progression and get a better visual outcome. Consequently, it is useful to clarify some aspects of the pathology that allow a better patient management.

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Section: Treatmentmentioning

confidence: 99%

“…Macular grid photocoagulation is an effective treatment to improve vision, but only for BRVO macular edema [2,3,4,5,6,7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30]. In CRVO, even if the treatment clearly reduces angiographic evidence of macular edema, macular grid photocoagulation results in no VA improvement [33].…”

Section: Treatmentmentioning

confidence: 99%

Retinal Vein Occlusion: Current Treatment

Lattanzio¹,

Gimeno

Parodi³

et al. 2010

Ophthalmologica

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“…Two RCTs have compared fibrinolytic therapy with no treatment [ 60 ] or hemodilution [ 61 ]. In the first study patients received intravenous streptokinase for 72 h followed by UFH and then warfarin for 6 months [ 60 ].…”

Section: Guidancementioning

confidence: 99%

“…Treatment was started within 7 days from symptoms onset. In the second study, patients received intravenous rt-PA for 60 min, UFH for 8 days and aspirin for 12 weeks and treatment was started within 11 days from symptoms onset [ 61 ]. There was a trend toward improved visual acuity in the groups of patients receiving active treatments, with similar rates of vitreous haemorrhage.…”

Section: Guidancementioning

confidence: 99%

Guidance for the management of venous thrombosis in unusual sites

Ageno

Beyer‐Westendorf²,

García

et al. 2016

J Thromb Thrombolysis

100

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Venous thromboembolism (VTE) is a serious and often fatal medical condition with an increasing incidence. The treatment of VTE is undergoing tremendous changes with the introduction of the new direct oral anticoagulants and clinicians need to understand new treatment paradigms. This manuscript, initiated by the Anticoagulation Forum, provides clinical guidance based on existing guidelines and consensus expert opinion where guidelines are lacking. In this chapter, we address the management of patients presenting with venous thrombosis in unusual sites, such as cerebral vein thrombosis, splanchnic vein thrombosis, and retinal vein occlusion. These events are less common than venous thrombosis of the lower limbs or pulmonary embolism, but are often more challenging, both for the severity of clinical presentations and outcomes and for the substantial lack of adequate evidence from clinical trials. Based on the available data, we suggest anticoagulant treatment for all patients with cerebral vein thrombosis and splanchnic vein thrombosis. However, in both groups a non-negligible proportion of patients may present with concomitant bleeding at the time of diagnosis. This should not contraindicate immediate anticoagulation in patients with cerebral vein thrombosis, whereas for patients with splanchnic vein thrombosis anticoagulant treatment should be considered only after the bleeding source has been successfully treated and after a careful assessment of the risk of recurrence. Finally, there is no sufficient evidence to support the routine use of antithrombotic drugs in patients with retinal vein occlusion. Future studies need to assess the safety and efficacy of the direct oral anticoagulants in these settings.

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“…Thus, the search for better therapeutic approaches continues. Emerging treatment modalities can be divided into those aimed to resolve the obstruction of venous outflow (endovascular fibrinolysis [105,106,107], endovascular cannulation [108], and systemic thrombolytics [109]) and those aimed at the sequelae of RVO (macular edema and macular ischemia). Therapies aimed at the latter can be grouped into those that minimize reperfusion injury [110], provide hemodilution [111], modify retinal vascular permeability [112], and offer neuroprotection [113] and pharmacologic vitreolysis [113,114,115,116,117].…”

Section: Emerging Therapiesmentioning

confidence: 99%

Optimal Treatment of Retinal Vein Occlusion: Canadian Expert Consensus

et al. 2015

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Background: The availability of new therapeutic approaches, particularly intravitreal anti-vascular endothelial growth factor (anti-VEGF) therapies, has prompted significant changes to the established treatment paradigms for retinal vein occlusion (RVO). Better visual outcomes and significantly lower rates of adverse events have been noted in multiple large randomized clinical trials and have led to a new standard of care for this sight-threatening condition. Objective: To develop an expert consensus for the management of RVO and associated complications in the context of recent clinical evidence. Methods: The development of a Canadian expert consensus for optimal treatment began with a review of clinical evidence, daily practice, and existing treatment guidelines and algorithms. The expert clinicians (11 Canadian retina specialists) met on February 1, 2014, in Toronto to discuss their findings and to propose strategies for consensus. Results: The result of this expert panel is a consensus proposal for Canadian ophthalmologists and retina specialists treating patients presenting with RVO. Treatment algorithms specific to branch and central RVO (BRVO and CRVO) were also developed. Conclusions: The consensus provides guidelines to aid clinicians in managing RVO and associated complications in their daily practice. In summary, laser remains the therapy of choice when neovascularization secondary to RVO is detected. Adjunctive anti-VEGF could be considered in managing neovascularization secondary to RVO in cases of vitreous hemorrhage. Intravitreal anti-VEGF should be considered for symptomatic visual loss associated with center-involving macular edema on optical coherence tomography. Patients with BRVO and a suboptimal response to anti-VEGF could be treated with grid laser, and those with CRVO and an inadequate response to anti-VEGF may be candidates for intravitreal steroids.

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Retinal Vein Occlusion and Low-Dose Fibrinolytic Therapy (R.O.L.F.)

Abstract: Treatment with intravenous low-dose rt-PA improved visual outcome in CRVO. Thrombolysis was not associated with a lower risk of ocular neovascularization, indicating that the mechanisms involved in this process occur at an early stage.

Cited by 34 publications

References 39 publications

Retinal Vein Occlusion: Current Treatment

Retinal Vein Occlusion: Current Treatment

Guidance for the management of venous thrombosis in unusual sites

Optimal Treatment of Retinal Vein Occlusion: Canadian Expert Consensus

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