Retinal Vein Occlusion Treatment & Management

  • Author: Mark Fonrose, MD, FACEP; Chief Editor: Robert E O'Connor, MD, MPH   more...
 
Updated: Jan 6, 2011
 

Emergency Department Care

The cornerstone of emergency department (ED) treatment for retinal vein occlusion may rest with the awareness of the disease entity by the ED physician. When considered in the proper clinical scenario, expeditious consultation by an ophthalmologist in the ED, can enable definitive diagnosis and so that appropriate intervention and follow-up care is ensured.

Treatment remains controversial at the present time. The Canadian Journal of Ophthalmology 2008 noted "No intervention has emerged as the standard of care. Current management in most centers is close observation for complications and treatment as they arise."[5] Another 2008 study notes that many different interventions have been advocated, but evidence is lacking as to their merit. Several randomized clinical trials are underway at the present time.[6]

Current literature and practice for the treatment of CRVO remains controversial. Vitreous Retina Macula Consultants of New York, a large and well-established retina practice group in New York City, advocates laser photocoagulation for managing rubeosis irides.[7] For the treatment of macular edema, they promote intraocular triamcinolone or bevacizumab (Avastin) in CRVO. In a small prospective, multicenter randomized, double-masked, placebo-controlled trial, intraocular injection of ranibizumab (0.5 mg) resulted in rapid improvement in 6-month visual acuity and macular edema, with low rates of ocular or nonocular safety events. Improvement required repeated injections. Further long-term study and follow up is needed.[8]

In one pilot study, simultaneous intravitreal injection of triamcinolone/tPA effectively reduced macular edema and improved the best corrected visual acuity (BCVA) in patients with CRVO without serious complications, although repeated treatments were required in 75%.[9]

Dalteparin was found superior to aspirin in improving visual acuity and preventing neovascularization in CRVO in a 2008 study.[10] Radial optic neurotomy (RON) has shown good results in improving visual loss in severe CRVO in a limited 2008 study.[5] Of note, a single case study in 2008 noted the use of hyperbaric oxygen, and subsequent visual improvement in a patient who refused other intervention.[11]

Current literature and practice for the treatment of BRVO is controversial as well. Vitreous Retina Macula Consultants of New York note that there is "no known medical treatment" for branch retinal vein occlusion.[7] A small study in 2008 noted intravitreal triamcinolone and grid laser photocoagulation effective in the treatment of BRVO.[12] In another 2008 study, triamcinolone acetonide retrobulbar injection was found effective for BRVO.[13] Pars plana vitrectomy was effective when the macular edema was resistant to improvement with triamcinolone alone.

Next

Consultations

Ophthalmologic consultation is mandatory. Management is outside the scope of emergency medicine.

Previous
Proceed to Medication
 
 
Contributor Information and Disclosures
Author

Mark Fonrose, MD, FACEP  Assistant Professor of Emergency Medicine, Kings County Hospital Center/State University of New York

Mark Fonrose, MD, FACEP is a member of the following medical societies: American College of Emergency Physicians

Disclosure: Nothing to disclose.

Specialty Editor Board

Joseph A Salomone III, MD  Associate Professor and Attending Staff, Truman Medical Centers, University of Missouri-Kansas City School of Medicine; EMS Medical Director, Kansas City, Missouri

Joseph A Salomone III, MD is a member of the following medical societies: American Academy of Emergency Medicine, National Association of EMS Physicians, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Senior Pharmacy Editor, eMedicine

Disclosure: eMedicine Salary Employment

Douglas Lavenburg, MD  Clinical Professor, Department of Emergency Medicine, Christiana Care Health Systems

Douglas Lavenburg, MD is a member of the following medical societies: American Society of Cataract and Refractive Surgery

Disclosure: Nothing to disclose.

John D Halamka, MD, MS  Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center

John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Robert E O'Connor, MD, MPH  Professor and Chair, Department of Emergency Medicine, University of Virginia Health System

Robert E O'Connor, MD, MPH is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American College of Physician Executives, American Heart Association, American Medical Association, Medical Society of Delaware, National Association of EMS Physicians, Society for Academic Emergency Medicine, and Wilderness Medical Society

Disclosure: Nothing to disclose.

References

  1. Madhusudhana KC, Newsom RS. Central retinal vein occlusion: the therapeutic options. Can J Ophthalmol. Apr 2007;42(2):193-5. [Medline].

  2. Ho JD, Tsai CY, Liou SW, et al. Seasonal variations in the occurrence of retinal vein occlusion: a five-year nationwide population-based study from Taiwan. Am J Ophthalmol. Apr 2008;145(4):722-728. [Medline].

  3. D'Amico DJ, Lit ES, Viola F. Lamina puncture for central retinal vein occlusion: results of a pilot trial. Arch Ophthalmol. Jul 2006;124(7):972-7. [Medline].

  4. Jonas JB, Harder B. Ophthalmodynamometric differences between ischemic vs nonischemic retinal vein occlusion. Am J Ophthalmol. Jan 2007;143(1):112-6. [Medline].

  5. Weis E, Gan KD, Hinz BJ, et al. A retrospective cohort study of radial optic neurotomy for severe central retinal vein occlusions. Can J Ophthalmol. Feb 2008;43(1):73-8. [Medline].

  6. Raja MS, Goldsmith C. Interventions for CRVO. Ophthalmology. Jan 2008;115(1):219; author reply 219-20. [Medline].

  7. Vitreous-Retina-Macula Consultants of New York. Retinal Venous occlusive Disease: Branch Retinal Occlusion/Central Retinal Occlusion. Available at www.vrmny.com. Accessed April 2008.

  8. Kinge B, Stordahl PB, Forsaa V, Fossen K, Haugstad M, Helgesen OH, et al. Efficacy of ranibizumab in patients with macular edema secondary to central retinal vein occlusion: results from the sham-controlled ROCC study. Am J Ophthalmol. Sep 2010;150(3):310-4. [Medline].

  9. Yamamoto T, Kamei M, Sayanagi K, Matsumura N, Nishida K, Sakaguchi H. Simultaneous intravitreal injection of triamcinolone acetonide and tissue plasminogen activator for central retinal vein occlusion: a pilot study. Br J Ophthalmol. Jan 2011;95(1):69-73. [Medline].

  10. Farahvash MS, Moghaddam MM, Moghimi S, et al. Dalteparin in the management of recent onset central retinal vein occlusion: a comparison with acetylsalicylic acid. Can J Ophthalmol. Feb 2008;43(1):79-83. [Medline].

  11. Wright JK, Franklin B, Zant E. Clinical case report: treatment of a central retinal vein occlusion with hyperbaric oxygen. Undersea Hyperb Med. Sep-Oct 2007;34(5):315-9. [Medline].

  12. Ozdek S, Deren YT, Gurelik G, et al. Posterior subtenon triamcinolone, intravitreal triamcinolone and grid laser photocoagulation for the treatment of macular edema in branch retinal vein occlusion. Ophthalmic Res. 2008;40(1):26-31. [Medline].

  13. Kawaji T, Takano A, Inomata Y, et al. Trans-Tenon's retrobulbar triamcinolone acetonide injection for macular oedema related to branch retinal vein occlusion. Br J Ophthalmol. Jan 2008;92(1):81-3. [Medline].

  14. Batioglu F, Astam N, Ozmert E. Rapid improvement of retinal and iris neovascularization after a single intravitreal bevacizumab injection in a patient with central retinal vein occlusion and neovascular glaucoma. Int Ophthalmol. Feb 2008;28(1):59-61. [Medline].

  15. Binder S, Aggermann T, Brunner S. Long-term effects of radial optic neurotomy for central retinal vein occlusion consecutive interventional case series. Graefes Arch Clin Exp Ophthalmol. Oct 2007;245(10):1447-52. [Medline].

  16. Ferrara DC, Koizumi H, Spaide RF. Early bevacizumab treatment of central retinal vein occlusion. Am J Ophthalmol. Dec 2007;144(6):864-71. [Medline].

  17. Gandhi JS. Natural history of non-ischemic central retinal vein occlusion versus iatrogenic intervention. J Postgrad Med. Oct-Dec 2007;53(4):270; author reply 270-1. [Medline].

  18. Gumus K, Kadayifcilar S, Eldem B, et al. Assessment of the role of thrombin activatable fibrinolysis inhibitor in retinal vein occlusion. Retina. Jun 2007;27(5):578-83. [Medline].

  19. Hasselbach HC, Ruefer F, Feltgen N, et al. Treatment of central retinal vein occlusion by radial optic neurotomy in 107 cases. Graefes Arch Clin Exp Ophthalmol. Aug 2007;245(8):1145-56. [Medline].

  20. Keith S, Humphries R. Current Diagnosis & Treatment of Emergency Medicine. 6th ed. McGraw-Hill Co; 2008.

  21. Koizumi H, Ferrara DC, Brue C, et al. Central retinal vein occlusion case-control study. Am J Ophthalmol. Dec 2007;144(6):858-863. [Medline].

  22. Kreutzer TC, Alge CS, Wolf AH, et al. Intravitreal bevacizumab for the treatment of macular oedema secondary to branch retinal vein occlusion. Br J Ophthalmol. Mar 2008;92(3):351-5. [Medline].

  23. Leoncini G, Bruzzese D, Signorello MG, et al. Platelet activation by collagen is increased in retinal vein occlusion. Thromb Haemost. Feb 2007;97(2):218-27. [Medline].

  24. Mohamed Q, McIntosh RL, Saw SM, et al. Interventions for central retinal vein occlusion: an evidence-based systematic review. Ophthalmology. Mar 2007;114(3):507-19, 524. [Medline].

  25. Morley M, Heier J. Ophthalmology. Part 8; Section 5. 2nd ed. Mosby; 2004.

  26. Recchia FM, Chen E, Li C, et al. Use of cox-2 inhibitors in patients with retinal venous occlusive disease. Retina. Jan 2008;28(1):134-7. [Medline].

  27. Sodi A, Giambene B, Marcucci R, et al. Atherosclerotic and thrombophilic risk factors in patients with recurrent central retinal vein occlusion. Eur J Ophthalmol. Mar-Apr 2008;18(2):233-8. [Medline].

 
Previous
Next
 
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2012 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.