VIENNA — A thorough ocular examination, early treatment and a timely switch of nonresponders are key for successful management of retinal vein occlusion, according to a specialist reporting on the Euretina guidelines for the management of retinal disease.
“First of all, we have convincing evidence that comprehensive systemic evaluation is not necessary for patients with vein occlusion unless they have simultaneous vein occlusion in both eyes and/or do not present the usual risk factors, such as hypertension and diabetes,” Anat Loewenstein, MD, said at the Euretina meeting.
Conversely, thorough ocular examination is needed, including visual acuity, clinical examination, fluorescein angiography and OCT. Widefield angiography and OCT angiography might be additional options but do not add relevant information for the management of the disease.
“It is important to treat early in the course of the disease. We know that the earlier we treat, the better the final VA,” Loewenstein said. “In all the RVO trials, including the recent CRYSTAL study, controls who started being treated at a later stage did not achieve the same VA as the patients who were treated from the start.”
As far as therapeutic options are concerned, anti-VEGF agents are now a well-established first-line treatment unless there are specific contraindications. For vein occlusion, all three anti-VEGF agents have shown high efficacy in studies.
“For nonresponders or for patients who are unable to come for frequent injections and monitoring, we consider the use of Ozurdex (dexamethasone intravitreal implant, Allergan), which most of the time leads to a good response,” Loewenstein said.
She said that the ocular side effects of Ozurdex are minimal and can usually be treated successfully.
Laser can be added in nonresponders, and when neovascularization develops, panretinal photocoagulation is warranted in addition to anti-VEGFs.
Finally, she noted that all patients with retinal vein occlusion should be treated, as they might benefit from the therapy and improve their vision even if they present with bad visual acuity at baseline. – by Michela Cimberle
Loewenstein A. Vein occlusion: The ten key messages. Presented at: Euretina; Sept. 20-23, 2018; Vienna.
Disclosure: Loewenstein reports she is a consultant for Alimera, Allergan, Bayer, ForSight Labs, Notal Vision and Novartis