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    Algorithms provide guidance for managing RVO-related macular edema

     

    Available algorithms

    Expert panels reviewing the available scientific evidence have developed algorithms that provide step-by-step recommendations for evaluation and management of macular edema secondary to RVO.

    Image 1: Right eye of a 70-year-old male with central retinal vein occlusion. The OCT shows increased thickness (CRT 441 um), lost foveal depression, and cystoid macular edema. (Image provided by Francisco J. Rodriguez, MD)

    According to algorithms published in 2015 by a group of 11 Canadian retinal specialists [Berger AR, et al. Ophthalmologica. 2015;234(1):6-25], initial treatment for branch retinal vein occlusion (BRVO) is guided by the presence or absence of neovascularization and macular edema, while macular edema is considered for central retinal vein occlusion (CRVO) patients.

    The panel recommended initial laser therapy for patients with BRVO and neovascularization with adjunctive use of an anti-VEGF agent if vitreous hemorrhage is also present. Initiating treatment with monthly anti-VEGF injections was recommended for eyes with macular edema and vision loss.

    Image 2: OCT of 70-year-old male's right eye following six anti-VEGF monthly injections. The thickness decreased to CRT 259 um, best-corrected visual acuity at last follow-up was 20/30. (Image provided by Francisco J. Rodriguez, MD)

    When patients start anti-VEGF therapy, the algorithm recommends evaluating response after three monthly injections. It proposes the use of intravitreal corticosteroids as second-line treatment for suboptimal responders with CRVO and grid laser for BRVO patients.

     

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