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Retinal Vein Occlusion Treatment & Management

  • Author: Jesse Borke, MD, FACEP, FAAEM; Chief Editor: Robert E O'Connor, MD, MPH  more...
 
Updated: Jan 22, 2015
 

Prehospital Care

There is no specific prehospital treatment for RVO.

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Emergency Department Care

The primary directive in the ED is to make the diagnosis clinically and arrange urgent consultation with the ophthalmologist. As there is no specific ED treatment for RVO, it does not represent a true “lights and sirens” emergency. However, because of the potential for permanent vision loss, no patient should leave the ED without a sound and specific plan for urgent ophthalmological evaluation. Same-day or next-day evaluation in the office or ED is appropriate.

The ophthalmologist’s treatment of RVO is aimed at maintaining visual acuity by monitoring the patient for and treating complications such as macular edema and neovascularization. In 2008, TheCanadian Journal of Ophthalmology 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."[6]

Macular edema in patients with RVO may be treated with intravitreal anti-VEGF (first line) and/or intravitreal steroids, while neovascularization in patients with RVO may be treated with laser photocoagulation. In refractory cases, vitrectomy may be required.

The primary doctor’s treatment of RVO is aimed at managing predisposing risk factors such as hypertension or coagulopathies.

Of note, a systematic review of multiple small randomized trials of antithrombotic and thrombolytic medications, including aspirin, clopidogrel (Plavix), heparin, and tPA, found limited or no benefit in RVO, owing mostly to lack of available evidence.[41] Currently, there is not enough evidence to recommend the routine use of antithrombotics in RVO, except in the case of a predisposing coagulopathy.

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Consultations

Consultation with an ophthalmologist is necessary. All patients require a sound and specific plan for urgent ophthalmological evaluation prior to discharge. Same-day or next-day evaluation is appropriate.

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Contributor Information and Disclosures
Author

Jesse Borke, MD, FACEP, FAAEM Medical Director, Emergency Department, Lakeview Hospital; Director of Process Improvement and Throughput, Kaleida Health Millard Fillmore Suburban

Jesse Borke, MD, FACEP, FAAEM is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American College of Physician Executives, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Coauthor(s)

Audrey Tai, DO, MS Resident Physician, Department of Ophthalmology, University of Buffalo State University of New York School of Medicine and Biomedical Sciences

Audrey Tai, DO, MS is a member of the following medical societies: American Academy of Ophthalmology

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

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.

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 Association for Physician Leadership, American Heart Association, Medical Society of Delaware, Society for Academic Emergency Medicine, Wilderness Medical Society, American Medical Association, National Association of EMS Physicians

Disclosure: Nothing to disclose.

Acknowledgements

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.

Richard J Spitz, MD Staff Physician, Assistant Professor of Emergency Medicine, Department of Surgery, Division of Emergency Medicine, University Of Texas Health Science Center

Disclosure: Nothing to disclose.

Loice Swisher, MD Assistant Professor, Department of Emergency Medicine, Mercy Hospital of Philadelphia

Disclosure: Nothing to disclose.

References
  1. Madhusudhana KC, Newsom RS. Central retinal vein occlusion: the therapeutic options. Can J Ophthalmol. 2007 Apr. 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. 2008 Apr. 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. 2006 Jul. 124(7):972-7. [Medline].

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

  5. Ascaso FJ, Padgett E, Núñez E, Villén L, Grzybowski A, Cristóbal JA. Branch retinal vein occlusion and vitreovascular traction: a preliminary spectral domain OCT case-control study. Graefes Arch Clin Exp Ophthalmol. 2014 Mar. 252(3):375-81. [Medline].

  6. 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. 2008 Feb. 43(1):73-8. [Medline].

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

  8. 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.

  9. 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. 2010 Sep. 150(3):310-4. [Medline].

  10. 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. 2011 Jan. 95(1):69-73. [Medline].

  11. 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. 2008 Feb. 43(1):79-83. [Medline].

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

  13. 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].

  14. 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. 2008 Jan. 92(1):81-3. [Medline].

  15. Papadia M, Misteli M, Jeannin B, Herbort CP. The influence of anti-VEGF therapy on present day management of macular edema due to BRVO and CRVO: a longitudinal analysis on visual function, injection time interval and complications. Int Ophthalmol. 2014 Sep 23. [Medline].

  16. Sarao V, Bertoli F, Veritti D, Lanzetta P. Pharmacotherapy for treatment of retinal vein occlusion. Expert Opin Pharmacother. 2014 Sep 5. 1-12. [Medline].

  17. 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. 2008 Feb. 28(1):59-61. [Medline].

  18. 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. 2007 Oct. 245(10):1447-52. [Medline].

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

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

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

  22. 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. 2007 Aug. 245(8):1145-56. [Medline].

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

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

  25. 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. 2008 Mar. 92(3):351-5. [Medline].

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

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

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

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

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

  31. Bowers DK, Finkelstein D, Wolff SM, Green WR. Branch retinal vein occlusion. A clinicopathologic case report. Retina. 1987. 7(4):252-9. [Medline].

  32. Zhao J, Sastry SM, Sperduto RD, Chew EY, Remaley NA. Arteriovenous crossing patterns in branch retinal vein occlusion. The Eye Disease Case-Control Study Group. Ophthalmology. 1993 Mar. 100(3):423-8. [Medline].

  33. Green WR, Chan CC, Hutchins GM, Terry JM. Central retinal vein occlusion: a prospective histopathologic study of 29 eyes in 28 cases. Retina. 1981. 1(1):27-55. [Medline].

  34. Newman-Casey PA, Stem M, Talwar N, Musch DC, Besirli CG, Stein JD. Risk factors associated with developing branch retinal vein occlusion among enrollees in a United States managed care plan. Ophthalmology. Oct. 121:1939-48.

  35. Hayreh SS, Podhajsky PA, Zimmerman MB. Natural history of visual outcome in central retinal vein occlusion. Ophthalmology. 2011 Jan. 118(1):119-133.e1-2. [Medline]. [Full Text].

  36. Rogers S, McIntosh RL, Cheung N, Lim L, Wang JJ, Mitchell P. The prevalence of retinal vein occlusion: pooled data from population studies from the United States, Europe, Asia, and Australia. Ophthalmology. 2010 Feb. 117(2):313-9.e1. [Medline].

  37. Klein R, Klein BE, Moss SE, Meuer SM. The epidemiology of retinal vein occlusion: the Beaver Dam Eye Study. Trans Am Ophthalmol Soc. 2000. 98:133-41; discussion 141-3. [Medline]. [Full Text].

  38. Natural history and clinical management of central retinal vein occlusion. The Central Vein Occlusion Study Group. Arch Ophthalmol. 1997 Apr. 115(4):486-91. [Medline].

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

 
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A: Central retinal vein occlusion (CRVO). B: Hemiretinal retinal vein occlusion (HRVO). C: Branch retinal vein occlusion (CRVO).
 
 
 
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