How is central retinal vein occlusion (CRVO) treated?

Updated: Apr 18, 2019
  • Author: Lakshmana M Kooragayala, MD; Chief Editor: Douglas R Lazzaro, MD, FAAO, FACS  more...
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Answer

No known effective medical treatment is available for the prevention or treatment of central retinal vein occlusion (CRVO). Identifying and treating any systemic medical problems to reduce further complications is important. Because the exact pathogenesis of the CRVO is not known, various medical modalities of treatment have been advocated by multiple authors with varying success in preventing complications and in preserving vision.

Macular edema is one of the prominent treatable causes of decreased visual acuity in patients with CRVO. The exact mechanism of macular edema is unclear, but multiple factors involved include increased venous pressure, elevated levels of VEGF, and deregulation of multiple inflammatory mediators leading to increased capillary permeability and leakage.

Various treatment modalities have been used to counter different components of macular edema pathogenesis, with significant progress in stabilizing or improving visual acuity.

Advocated treatments are as follows:

  • Aspirin

  • Anti-inflammatory agents

  • Isovolemic hemodilution

  • Plasmapheresis

  • Systemic anticoagulation with warfarin, heparin, and alteplase

  • Fibrinolytic agents

  • Systemic corticosteroids

  • Local anticoagulation with intravitreal injection of alteplase

  • Intravitreal injection of ranibizumab

  • Intravitreal injection of aflibercept

  • Intravitreal injection of triamcinolone

  • Intravitreal injection of bevacizumab

  • Dexamethasone intravitreal implant

The Ophthalmic Technology Assessment Committee Retina/Vitreous panel of the American Academy of Ophthalmology evaluated available literature regarding efficacy of available pharmacotherapies in the treatment of macular edema due to CRVO. The panel reported that intravitreal anti-VEGF therapy is safe and effective over 2 years for macular edema and that delayed treatment is associated with worse visual outcomes. Intravitreal corticosteroid therapy yielded short-term efficacy but was associated with a higher frequency of adverse events. [27]


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