Guidelines for management Non-ischaemic CRVO
• If VA ≤6/12 + OCT ≥250 microns, consider Ozurdex or AntiVEGF
• if VA <6/60 or RAPD ( manage as ischaemic CRVO).
• Retreat with Ozurdex at 4–6mth intervals.
• For AntiVEGF, consider monthly injections for 6–12months , and then as required.
• Can be discharged if stable by 24months
Guidelines for management of Ischaemic CRVO with no NV
• Examination (including gonioscopy) monthly for 6 months , then every 3 months for 1 yr .
• can be discharged if stable by 24 months
Guidelines for management of Ischaemic with neovascularization (angle or iris)
• PRP (1,500–2,000 × 500 microns × 0.05–0.10)
• consider combined use of AntiVEGF
• follow-up every 6 wks
• repeat treatment if NVI/NVA persists
Guidelines for management of NVG with visual potential
• control of IOP with topical agents or cycloablation
• PRP or AntiVEGF
• atropine and Cyclopento
• shunt surgery
Guidelines for management of NVG in blind eye
Keep the eye comfortable in any way
• topical agents
•CPC
•CCA
•Evisceration
Guidelines for management of CRVO powerpoint presentation:
Manangement of Retinal Vein Occlusion
Central Retinal Vein Occlsion (CRVO)
1. RETINAL VEIN OCCLUSION Dr. Yousaf Jamal FCPS Resident Ophthalmology Unit Hayatabad Medical Complex
2. Contents• Introduction of RVO• CRVO – Demographics – Pathogenesis – Etiology – Management • Hx, examination, investigation • Treatment – Trials – Guidelines• Summary / Take Home Message• MCQs Page 2 Retinal Vein Occlusion
3. Introduction• Common vascular disorder• Second common cause of blindness after diabetic retinopathy• Cause…obstruction to venous flow• Associated risk factors….multifactorial• Classification – Site of involvement – Extent of retinal perfusion Page 3 Retinal Vein Occlusion
4. Demographics• In Australia, prevalence of RVO… – 0.7% in pts aged 49-60 years to 4.6% in pts older than 80 years a• Seasonal variation found…greater than 20,000 patients in the month of January ba Mitchell P, Smith W, Chang A. Prevalence and associations of retinal vein occlusion in Australia. The Blue Mountains Eye Study. Arch Ophthalmol. Oct 1996;114(10):1243-7b Ho JD, Tsai CY, Liou SW, et al. Seasonal variations in the occurrence of retinal vein occlusion: a five-year nationwide population- based study from Taiwan. Am J Ophthalmol. Apr 2008;145(4):722-728. Page 4 Retinal Vein Occlusion
5. Common mechanism Venous blockage back pressure on capillaries endothelial junction dysfunction leakage of fluid & blood (edema / hemorrhages)• Severe nonperfusion leads to ischemia Page 5 Retinal Vein Occlusion
6. Predominant associationsPatient Hypertensio Hyperlipidemia Diabetes No Obvious Group n Mellitus CauseAge<50 25% 35% 03% 40% yrsAge>50 64% 34% 4-15% 21% yrs Asian 64% 50% 29% 10.7% West 83% 33% 38% 8.3% IndianRecurren 88% 47% 3% 6% t cases• Royal college of ophthalmologists guidelines: Feb. 2009 Page 6 Retinal Vein Occlusion
7. Classification• Central retinal vein occlusion (CRVO) – Non-ischemic CRVO – Ischemic CRVO• Branch retinal vein occlusion (BRVO) – Major BRVO – Macular BRVO• Hemicentral retinal vein occlusion (HCRVO) – Non-ischemic HCRVO – Ischemic HCRVO Page 7 Retinal Vein Occlusion
8. Central retinal vein occlusion• Painless loss of vision• Site: occlusion at or posterior to lamina cribrosa• Two clinical types – Ischemic CRVO (I-CRVO) – Non-ischemic (NI-CRVO)• ‘Research into CRVO is fraught with challenges, from accurate disease classification to its treatment; even the most prestigious trials have become controversial’• Madhusudhana KC, Newsom RS.Central retinal vein occlusion: the therapeutic options. Can J Ophthalmol.Apr 2007;42(2):193-5. Page 8 Retinal Vein Occlusion
CRVO AND NVG MANAGEMENT
Guidelines for management of CRVO Videos:
What is Central Retinal Vein Occlusion? (CRVO) – YouTube
Retinal Vein Occlusion – Nattokinase As Possible Treatment or …
Retinal vein occlusion treatment – YouTube
CRVO AND NVG MANAGEMENT – YouTube
Guidelines for management of CRVO