13.5  Medical Retina – Retinal Vein Occlusion (RVO)

IVB = Bevacizumab, IVR = Ranibizumab, IVA = Aflibercept, IVTA = Triamcinolone

BVOS [lv,lvi]

Laser for BRVO macular oedema

For BRVO > 3 months duration, VA 6/12 or worse, no macular haemorrhage:

Macular grid laser = 2x chance of VA gain of 2 lines

Sectoral PRP for NV reduces risk of VH

CVOS [lvii,lviii]

Laser for CRVO macular oedema

Macular laser not beneficial for macular oedema

PRP for NV only once it develops

If ischaemic CRVO - monthly F/U

1995. Evaluation of grid pattern photocoagulation for macular edema in central vein occlusion. The Central Vein Occlusion Study Group M report. Ophthalmology 102(10) 1425-1433.

1995. A randomized clinical trial of early panretinal photocoagulation for ischemic central vein occlusion. The Central Vein Occlusion Study Group N report. Ophthalmology 102(10) 1434-1444.

SCORE [lix,lx]

IVT for BRVO/CRVO macular oedema

IVTA no different to macular grid laser for BRVO macular oedema (but 4mg IVTA had greater IOP rise and cataract)

IVTA superior to observation for CRVO (1mg better than 4mg in terms of safety)

BRAVO [lxi]

BRVO macular oedema

IVR effective (improved 3 lines vs. improved 1.5 lines sham)

Brown, D.M., Campochiaro, P.A., Bhisitkul, R.B. et al. 2011. Sustained Benefits from Ranibizumab for Macular Edema Following Branch Retinal Vein Occlusion: 12-Month Outcomes of a Phase III Study. Ophthalmology 118(8) 1594-1602.

CRUISE [lxii]

Non-ischaemic CRVO macular oedema

IVR effective (improved 3 lines vs. improved 0 lines sham)

Brown, D.M., Campochiaro, P.A., Singh, R.P. et al. 2010. Ranibizumab for Macular Edema following Central Retinal Vein Occlusion: Six-Month Primary End Point Results of a Phase III Study. Ophthalmology 117(6) 1124-1133.e1121.

OZURDEX GENEVA STUDY [lxiii,lxiv]

BRVO/CRVO macular oedema

Ozurdex effective (reduced vision loss, improved speed and incidence of visual improvement) compared with sham at 6 months

VIBRANT [lxv]

IVA vs grid laser for BRVO macular oedema

IVA superior to grid laser at 6 months with regards to vision and macular thickness

Campochiaro, P.A., Clark, W.L., Boyer, D.S. et al. 2015. Intravitreal Aflibercept for Macular Edema Following Branch Retinal Vein Occlusion: The 24-Week Results of the VIBRANT Study. Ophthalmology 122(3) 538-544.

          

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