BRVO management of Macular oedema with no or minimal macular ischaemia
• Within 3months of onset: consider Ozurdex or AntiVEGF
• After 3months of onset: consider macular grid laser (20–100 × 100–200 microns × 0.10 ) or Ozurdex or AntiVEGF
• Retreat with Ozurdex at 4–6 months intervals.
• AntiVEGF consider monthly injections for 6 months and then whenever needed .
• Retreatment with macular grid laser should be considered at 4-monthly intervals.
• If stable, can usually be discharged by 24months
BRVO management of Macular oedema with marked macular ischemia management
• no immediate treatment is recommended.
• Monitor for development of neovascularization
• AntiVEGF or Ozurdex can be tried
Ischaemic BRVO without NV management
• Review at monthly for 3months then every 3 months
• if stable, can usually be discharged by 24months
Ischaemic BRVO with NV management
• Sectoral PRP (400–500 × 500 microns × 0.05–0.10) ± AntiVEGF
• Follow-up as ischemic without NV
Guidelines for BRVO management powerpoint presentation:
BRVO MANAGEMENT 2016
BRVO MANAGEMENT 2016
1. BRVO MANAGEMENT 2016 INTRAVITREAL INJ & LASER
2. DR DINESH MITTAL DR SONALEE MITTAL DRISHTI EYE HOSP VIJAYNAGAR INDORE
3. BRVO • Branch retinal vein occlusion (BRVO) is a common cause of retinal vascular disease. The Beaver Dam Study estimated the 15-year cumulative incidence of retinal vein occlusions (RVO) at 2.3% in the population, with a majority of these (78%) being BRVO. BRVO affects males and females equally and occurs most frequently between the ages of 60 and 70. The pathologic interruption of venous ﬂow in these eyes almost always occurs at a retinal arteriovenous intersection, where a retinal artery crosses over a retinal vein. Systemic vascular diseases such as hypertension and arteriosclerosis are risk factors for BRVO, probably because they lead to thickening of the retinal artery. •
4. PATHOGENESIS • Because BRVO mostly occurs at arteriovenous crossings, underlying arterial disease may play a causative role. In 99% of 106 eyes with BRVO, the artery was located anterior to the vein at the obstructed site. Histopathologically, the retinal artery and vein share a common adventitial sheath, and in some cases, a common medium. The lumen of vein may be compressed up to 33% at the crossing site.
5. VISION loss from RVOs is typically due to • macular ischemia, • macular edema, • or complications from neovascular disease
6. CLINICAL FEATURES Symptoms •Patients with BRVO present with sudden painless loss of vision or a visual ﬁeld defect. Subclinical presentations may occur if a tributary distal to the macula or a nasal retinal vein is involved. Rarely, patients with BRVO will present with ﬂoaters from a vitreous hemorrhage if the initial vein occlusion was unrecognized and retinal neovascularization has occurred.
7. CLINICAL FEATURES Signs • Patients typically present with a wedge-shaped distribution of intraretinal hemorrhage that is less marked if the occlusion is perfused (or nonischemic), and more extensive if the occlusion is nonperfused (or ischemic) and associated with retinal capillary nonperfusion. The Branch Vein Occlusion Study Group deﬁned ischemic BRVO as those with greater than a total of ﬁve disc diameters of nonperfusion on ﬂuorescein angiography (FA).
Branch Retinal Vein Occlsion (BRVO)
Guidelines for BRVO management Videos:
BRVO management Medication Injections by Retina Consultants of Southern California
Guidelines for management of BRVO