Treatment of macular edema due to retinal vein occlusions

Abstract

Retinal vein occlusion (RVO) is a prevalent retinal vascular disease, second only to diabetic retinopathy. Previously there was no treatment for central retinal vein occlusion (CRVO) and patients were simply observed for the development of severe complications, generally resulting in poor visual outcomes. The only treatment for branch vein occlusion (BRVO) was grid laser photocoagulation, which reduces edema very slowly and provides benefit in some, but not all patients. Within the past year, clinical trials have demonstrated the effects of three new pharmacologic treatments, ranibizumab, triamcinolone acetonide, and dexamethasone implants. The benefit/risk ratio is best for intraocular injections of ranibizumab, making this first-line therapy for most patients with CRVO or BRVO, while intraocular steroids are likely to play adjunctive roles. Standard care for patients with RVO has changed and will continue to evolve as results with other new agents are revealed.

Keywords:

• vascular endothelial growth factor
• triamcinolone acetonide
• dexamethosone implant
• sustained release
• vascular leakage
• ischemia

Disclosure

PAC has standard consulting agreements with LPath, Ora, Amira, Allergan, Pfizer, and Bristol Myers Squibb and has institutional consulting agreements with Genentech and GlaxoSmithKline through which his employer, Johns Hopkins University, receives compensation. He receives research support from Genentech, Alimera, Alcon, GlaxoSmithKline, Oxford BioMedica, and Genezyme. The other authors have no potential conflicts.