Current Treatments in Central Retinal Vein Occlusion

Dr. Neslihan Bayraktar Bilen

Ankara Bilkent City Hospital, Department of Ophthalmology, Ankara, Türkiye

ABSTRACT

Central retinal vein occlusion (CRVO) is one of the retinal vascular diseases that causes severe vision loss. It has ischemic and non-ischemic types. The most important cause of vision loss is macular edema. Intrav- itreal anti-vascular endothelial growth factor (VEGF) agents are the first line treatment of macular edema. Ranibizumab (Lucentis), bevacizumab (Avastin), and aflibercept (Eylea) are actively used. FDA approved faricimab (Vabysmo) for the treatment of CRVO at the end of 2023. Treatment of macular edema is started with an anti-VEGF. Patients’ response to treatment is variable; some patients show complete recovery with few relapses, while others show partial or no response with frequent relapses. After 3 monthly loading doses of anti-VEGF, the patient is evaluated according to whether the macular edema has regressed on optical co- herence tomography. Depending on the response to treatment, the same anti-VEGF treatment is continued or an alternative anti-VEGF treatment is switched. Aflibercept is the most widely tested anti-VEGF in ischemic type CRVO. Steroids [triamcinolone, dexamethasone implant (Ozurdex)] are the second-line treatment for macular edema because of their side effect profiles such as cataract and glaucoma. They are used in patients who do not respond to anti-VEGF therapy, have had a recent cardiovascular event, and cannot frequently visit the hospital for anti-VEGF treatment. In ischemic type CRVO, the risk of neovascularization in the iris, angle and retina is high. Panretinal photocoagulation (PRP) is the gold standard in CRVO for complications such as retinal and iris neovascularization to prevent vitreous hemorrhage and neovascular glaucoma. PRP is recommended when iris neovascularization becomes evident. Intravitreal anti-VEGF treatment can delay but not prevent neovascularization. Combination therapy with PRP and angiogenesis inhibitors is used in the treatment of NVG.

Keywords: Central retinal vein occlusion; Macular edema; Treatment; Laser; Steroid; Anti-VEGF

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