Clinical-Therapeutic Orientation in Retinal Venous Obstruction

Abstract

Retinal vein occlusion (RVO) is a retinal vascular disease that can affect the central retinal vein in central retinal vein occlusion (CRVO) or branch retinal vein occlusion (BRVO), which causes decreased vision (the second leading cause of blindness after diabetic retinopathy). CRVO is accompanied by retinomacular edema and retinal / peripapillary / iris neovascularization that cause serious complications: absolute neovascular secondary glaucoma, vitreous hemorrhage, retinal traction detachment, possibly present in both forms of CRVO. Branch retinal vein occlusion (BRVO) is often asymptomatic and can be diagnosed accidentally or by retinal control, and is 5 times more common than CRVO. CRVO prophylaxis is done by identifying and appropriate treatment of risk factors (multiple): hypertension, diabetes, smoking, obesity, Primary Open Angle Glaucoma (POAG), hypercoagulability. RVO treatment, the non-ischemic form, requires the treatment of macular edema with: intravitreal AntiVEGF - Ranibizumab, Aflibercept, Bevacizumab, repeatedly, cortisone therapy with intravitreal Triamcinolone or Dexamethasone implant, focal / grid laser photocoagulation and / or panretinal photocoagulation. In all cases of RVO, the non-ischemic form, the following are required: clinical surveillance, fluorescein angiography (FA), OCT for immediate detection of progression to the ischemic form. The treatment of RVO, ischemic form, is the treatment of macular edema with repeated intravitreal antiVEGF treatment, corticosteroids, focal laser photocoagulation, grid, pan-photocoagulation indicated in the treatment of exudative ischemic areas with neovessels proliferation. Panretinal photocoagulation (PRP) is an effective treatment for iris peripapillary retinal neovascularization and secondary complications. The current prognosis of RVO is improved by regular examination of OCT-SD, antiVEGF medication, intravitreal cortisone and laser photocoagulation that provide prophylactic and curative treatment of RVO and complications: vitreous hemorrhage, neovascular glaucoma, retinal traction detachment.