7. Early studies
• BVOS verified Laser therapy for BRVO
– 1984
• CVOS Observation as the standard care for
CRVO
– 1995
8.
9.
10. • Investigate and treat associated systemic
disease (e.g. HTN, DM, hyperlipidemia)
• Wait for hemorrhage to clear (3 months)
• Perform FFA at 3 months
– If macular edema is present and VA < 20/40
grid laser photocoagulation
– If 5 disc diameter of nonperfusion is seen
close follow-up to look for neovascularization
– Once new vessels are seen
sector PRP is indicated
11. • Need to differentiate ischemid/nonischemic CRVO
• Wait for hemorrhage to clear (3 months)
• Perform FFA at 3 months
– If nonischemic
no treatment is needed, prognosis is good (50% 20/40
of better VA)
– If ischemic
prognosis is poor (50% neovascular glaucoma in 3
months), close follow-up is needed to look for new vessels
at the iris
• Once new vessels at the iris are seen
full PRP is indicated
• No benefit in treating macular edema in CRVO
12.
13. • Standard Care vs Corticosteroid for Retinal Vein
Occlusion
• 2009
• SCORE-BRVO
• SCORE-CRVO
• To compare
– Standard care
– 1.0 mg IVTA
– 4.0 mg IVTA
15. • IVTA superior to observation
• 1.0 mg had superior safety profile than 4.0 mg
SCORE-CRVO
Observation 1 mg IVTA 4 mg IVTA
>15 letters VA gain 7% 27% 26%
Need for IOP-lowering medx 8% 20% 35%
Progression of cataract 18% 26% 33%
16. SCORE-BRVO
Standard care 1.0 mg IVTA 4.0 mg IVTA
>15 letters VA gain 29% 26% 27%
Need for IOP-lowering medx 2% 8% 41%
Progression of cataract 13% 25% 35%
17. SCORE-BRVO
• No significant difference among 3 groups with
respect to VA nor CMT at 12 months
• At 3 years, VA & CMT were in favor of
standard care group
• Laser remained the
standard treatment
of choice in macular
edema secondary to
BRVO
27. • VA < 0.5 with Macular Edema
– Grid laser photocoagulation
– Intravitreal anti-VEGF if grid laser treatment failure or in
eyes with extensive macular hemorrhage
• VA > 0.5
– Consider intravitreal anti-VEGF as primary treatment
• If 5 disc diameter of non-perfusion is seen
– close follow-up looking for NV
• Once new vessels are seen
– Sector Argon photocoagulation
28. Other treatment modalities
• IVTA
– Does not improve VA in macular edema
– Significant side effects of raised IOP and cataract
• Dexamethasone implant
– Improves VA in macular edema
– Side effects of raised IOP and cataract
• PPV with AV sheathotomy
