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[Emergency] Atlas of Central Retinal Vein Occlusion

Patients are usually older individuals and complain of sudden, painless visual loss in one eye. The vision loss is usually not as severe as CRAO and may vary from normal to hand motion.

Treatment is rarely effective in preventing or reversing the damage done by the occlusion and is directed toward systemic evaluation to identify and treat contributing factors, hopefully decreasing the chance of contralateral CRVO.

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 RVO Workup: When it's Necessary and What to Order

RVO can happen at any age but is most common in patients over age 65. Vein occlusion shares risk factors of atherosclerosis. The clinician should direct the workup toward evaluation of hypertension, hyperlipidemia and diabetes. Thrombophilia testing is rarely needed, but can be considered in patients who have a family history of clotting under the age of 50, a personal history of clotting or an unusual presentation such as bilateral simultaneous occlusion.

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An Overview of Retinal Vein Occlusion

In its purest form, a retinal vein occlusion is a blockage of one of the venules that we see coming off either the central retinal vein itself, or one of the venules coming off of it. This is different than other blockages of veins we see in the body. These are generally occlusions, they’re not necessarily clots in those veins, although there are scenarios where it can be...

Central retinal vein occlusion and thrombophilia

Central retinal vein occlusion is one of the commonest vascular diseases of the eye. The pathogenesis is multifactorial with both local factors and systemic diseases being aetiologically important. Many thrombophilic conditions have recently been identified and studies looking at their potential role in CRVO have been undertaken.

Evaluation and Management Of Retinal Vein Occlusion

Retinal venous occlusive disease is the most common retinal vascular disorder after diabetic retinopathy. Early recognition and treatment are important to avoid potentially significant visual morbidity.

Retinal vein occlusion: time for action has come

The direct management of sight-threatening complications in patients with RVO primarily involves the ophthalmologist with the potential application of different strategies including surgical approaches, laser therapy, the administration of intravitreal steroids or hemodilution, and other promising treatments such as intravitreal anti-vascular endothelial growth factor drugs.

Retinal Vein Occlusions: Diagnosis and Management

Each type of retinal vein occlusion can be differentiated by the appearance of the retina on funduscopic examination. A CRVO has an appearance that is commonly characterized as a “blood and thunder.

Treatments for Central Retinal Vein Occlusion

Currently there is no established standard of care for central retinal vein occlusion (CRVO). The conditions that are targeted by current treatments are neovascularization and macular edema. Panretinal photocoagulation (PRP) is accepted as an established treatment for neovascularization, but a consensus has not yet been reached on the indications for and timing of the procedure. Recent large-scale clinical trials have shown anti-VEGF therapy to be effective for the management of macular edema, but the benefits are limited and the long-term effects are unknown.

Resources

MacularSociety.org

Anti-VEGF injections (Eylea, Lucentis) or steroid implants (Ozurdex) injected into the eye is used to treat RVO. The injections have to be repeated over a period of time to work effectively. Injection treatment aims to stabilise or improve vision. About 45-55% of patients treated with anti-VEGF injections experience a significant improvement in vision.

EyeRounds.org

Central retinal vein occlusion (CRVO) is a common cause of marked or total loss of vision in the middle-aged and elderly population, but no age group is immune to it. Although the disease entity has been known since 1878 and a large volume of literature has been published on the subject, its management is still ill-understood and controversial.

EyeWiki

There is no convincing evidence of medical treatment favorably altering the natural course of the central retinal vein occlusion itself. Pilot studies have suggested that oral inhibitor of platelet and erythrocyte aggregation, and hemodilution treatment to lower blood viscosity may be of some benefit. Intravenous administration of streptokinase appeared to reduce the morbidity but has never gained favor because of the risk of vitreous hemorrhage.

American College of Physicians

Visual prognosis is poor in the ischemic variety with residual macular edema often limiting visual recovery. Laser photocoagulation is sometimes used as treatment with varying success. Importantly, the incidence of neovascular glaucoma developing is high (60% in the very ischemic eyes) usually within 3-5 months.

Janigian Retina Associates

There is no cure for retinal vein occlusions because current medical technology cannot remove or dissolve the blockage. We do however have a number of medications that are injected into the eye to treat the vision threatening effects of retinal vein occlusion (see Anti-VEGF medications). Laser used to be the mainstay of treatment for this condition, but it is now reserved for only special circumstances.

StatPearls

Retinal vein occlusion (RVO) is the second most common retinal vascular disease and is a common loss of vision in older patients. There are two types of RVO: Branch retinal vein occlusion (BRVO) and central retinal vein occlusion (CRVO).

WikEM

No treatment regimen provides significant and consistent results.