Retinal Vein Occlusion Clinical Practice Guidelines (2019)

European Society of Retina Specialists

This is a quick summary of the guidelines without analysis or commentary. For more information, go directly to the guidelines by clicking the link in the reference.

September 03, 2019

In August 2019, the European Society of Retina Specialists (EURETINA) published clinical practice guidelines on the management of retinal vein occlusion (RVO).[1]

Patients with suspected retinal vein occlusion (RVO) should undergo a full ophthalmologic examination, including measurement of visual acuity (VA), evaluation of the fundus, and (to rule out neovascularization) assessment of the iris.

Optical coherence tomography imaging is effective in the diagnosis of RVO-associated macular edema.

Panretinal laser photocoagulation represents the standard of care for the management of RVO-associated neovascular complications, including retinal and disc neovascularization secondary to branch retinal vein occlusion (BRVO) or central retinal vein occlusion (CRVO), as well as iris neovascularization.

Owing to the availability of anti-vascular endothelial growth factor (anti-VEGF) therapy, focal laser photocoagulation should be considered only as a second-line treatment for macular edema secondary to BRVO.

Ranibizumab has, through several randomized, controlled studies, been shown to be safe and effective in the treatment of RVO-associated macular edema. Anatomic and functional improvement in BRVO and CRVO have been achieved through an individualized dosing regimen of 0.5 mg ranibizumab.

Early treatment with intravitreal aflibercept, an agent shown to be effective against macular edema secondary to RVO, is associated with optimal results in such edema.

Comparative, noninferiority trials showed bevacizumab’s effectiveness in reducing macular thickness. Used in monthly and “as needed” (prn) regimens, bevacizumab has been found improve VA in cases of RVO-associated macular edema.

Existing data demonstrate that corticosteroids are important agents for the treatment of RVO, but they are primarily a second-line choice. It is reasonable to switch to steroid therapy in patients who have not responded to anti-VEGF treatment (following 3-6 injections, based on each patient’s specific response).

Consideration of steroids as a first-line therapy is permissible in patients with a recent history of a major cardiovascular event and in those who balk at coming in for monthly injections (and/or monitoring) in the first 6 months of therapy.

Evaluation of a patient newly diagnosed with RVO should, at minimum, include a detailed medical history, blood pressure measurement, sugar evaluation, a full blood count, assessment of erythrocyte sedimentation rate, and C-reactive protein measurement. Nightly nondipping or overdipping can be avoided through regular follow-up with 24-hour blood pressure measurements.

For more information, please go to Retinal Vein Occlusion (RVO), Branch Retinal Vein Occlusion (BRVO), and Central Retinal Vein Occlusion (CRVO).

For more Clinical Practice Guidelines, please go to Guidelines.

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