Principles of retinal vein obstruction treatment

  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 only ranibizumab or tretinoin (with more side effects) or combined with 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 the use of intravenous infusion treatment, oral drug effect is not sure, Chinese medicine generally does not play a major role), close observation, you can do OCT (4-6 weeks once) and fluorescence imaging (about 2 months once), once there is ischemia performance, you have to do the whole retina laser photocoagulation (general laser 2-3 times ). Ischemic type: whole retina laser photocoagulation + intraocular injection of anti-VEGF drugs. Close observation is needed to prevent neovascular glaucoma, and if neovascular glaucoma has already occurred, it is treated according to the principles of “neovascular glaucoma”.  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 a collateral circulation and have a slightly better prognosis, most of them have a poor prognosis, and most of them end up with a visual acuity of about 0.1 (maybe better than 0.1 when first treated). The main goal of treatment is not to improve the amount of vision, but to: 1. prevent the formation of retinal neovascularization – resulting in vitreous blood accumulation, proliferation, retinal detachment; 2. prevent the occurrence of neovascular glaucoma – for visual function is devastating, and high intraocular pressure pain is unbearable!