My first choice is vitrectomy (including A-V sheathotomy & internal limitting membrane peeling) in case have below condition:
1 Artery on vein
2 occlusion not in disc or on disc
3 short duration from onset (less than 1-2 month)
4 Visual acuity less than 20/30
5 Foveal macular thickness more than 450 micron
6 Patient accept operation
Second choice is Anti-VEGF therapy or Subtennon steroid therapy.
And I never perform photocoagulation for non perfusion area in initial therapy.
Please tell me your recommend therapy and your opinion.
really? I think that in 2013 we have different less invasive and with better prognosis strategies...
i am doing the research in medical image processing...i need a golden standard categorized images for arcus senilis ,cholesterol deposits in the retina and cholesterol emboli.. can you tell from where i get the images?
Thank you for response Enzo. I wrote that virectomy is first choice, but I ussually use anti VEGF (avastin or ranibizumab) in many cases do not consent to operation. However impact of vIrectomy is controversially, I think VItrectomy (including AVS ILM peeling) has a permanent effect for BRVO macular edema. Please tell me about your strategy.
Don't be mean to your VR surgeon. We rarely see a case of BRVO that has not already had the full run of medical treatments. The trouble is that we generally will perform a large number of procedures at the same time as the vitrectomy including laser and steroid injection, so it is little wonder that we usually get a treatment response. There is little chance that we would get enough patients to perform a RCT to find out why, lucentis seems to work too well.
The treatment options are different , depends of the duration of BRVO , extention , macular involvement , visual acuity , and the doppler of Carotis to determine the % of oclussion on Carotis, the age of patient . But i agree with all my colegues that BRVO is an ocular emergency and must be treated like this . VEGF alone or combined with ozurdex or laser i think has better results than PPV . Follow -up must be made by doing OCT or if needed angiography monthly .
Thank you !
What is the best therapy for branch retinal vein occlusion? In my opinion the best therapy will be found in the near future, since available approaches ( anti-VEGF, Ozurdex, PPV, laser) have pros and cones ( ocular side effecs, systemic side effects, short duration of action and recurrence of macular edema,tachyphylaxy, economic impact-cost effect, etc.
Pathogenesis of branch retinal vein occlusion (BRVO) is multifactorial. In general, BRVO has a good prognosis: 50–60% of eyes are reported to have a final VA of 20/40 or better even without treatment.
Nevertheless, grid laser photocoagulation was an established treatment for macular edema in a particular group of patients with BRVO, however promising results for this condition are shown by intravitreal application of steroids (Ozurdex) or anti-VEGF. Recent reports (AAO Subspecialty Day 2013) demonstrate that anti-VEGF will lead to a much better visual results that laser therapy. If there is loss of VA I do start my patients on anti-VEGF (Avastin or Lucentis).
Vitrectomy with or without arteriovenous sheathotomy combined with removal of the internal limiting membrane may improve vision in eyes with macular edema, which are unresponsive to or ineligible for pharmacotherapy or laser treatment.
If BRVO is less than 1 month duration and vision is better than 6/12, i prefer to watch as pt recover by 2 months. If edema is gross or patient is too apprehensive, I inject anti VEGF..If patient has chronic diffuse leak then I laser.
Until patinet has more dense vitreous hgh leadig to poor vision or TRD , I never operate
the latest data revealed the efficacy of Aflibercept in BRVO comparing with grid laser treatment
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