Retrieved from: 2014-07-05 Youxin Chen’s World of Ophthalmology
Retinal vein obstruction is divided into branch vein and central vein obstruction. The prognosis of branch vein obstruction is better and the treatment is mainly: vitreous cavity injection of anti-VEGF drugs, currently available as razumab or tretinoin (with some side effects) or combined laser treatment. The aim is to eliminate edema and prevent neovascularization.
The overall goal of treatment is to prevent neovascularization, especially neovascular glaucoma, because once neovascular glaucoma develops, the prognosis is very poor, and in severe cases, the eye is even removed.
Central venous obstruction is divided into: edema type and ischemic type.
Edema type: the main treatment is intraocular injection of anti-VEGF or hormonal drugs (generally do not advocate intravenous infusion treatment, oral drug effect is not sure, Chinese medicine generally does not play a major role), close observation, can do OCT (4-6 weeks once) and fluorescence imaging (about once every 2 months), once there is ischemia performance, you have to do the whole retina laser photocoagulation (usually laser 2-3 times ).
Ischemic type: total retinal laser photocoagulation + intraocular injection of anti-VEGF drugs. Close observation to prevent neovascular glaucoma, or if neovascular glaucoma has already occurred, follow the principles of neovascular glaucoma management described later.
The following diagram shows branch retinal vein obstruction.
The following figure shows central retinal vein occlusion.
It is important to emphasize that the treatment of central retinal vein obstruction is very, very difficult! If the blockage is severe, it cannot be recanalized, a few can form collateral circulation and have a slightly better prognosis, most have a poor prognosis, and most of the vision will end up around 0.1 (probably better than 0.1 when first treated).
The main goal of treatment is not to improve the amount of visual acuity, but to.
1. to prevent the formation of retinal neovascularization – resulting in vitreous blood accumulation, proliferation, and retinal detachment.
2, to prevent the occurrence of neovascular glaucoma – devastating to visual function, and painful with high intraocular pressure!