Retinal Vein Occlusions
HIGHLIGHTED FINDINGS AND RECOMMENDATIONS FOR CARE
Central retinal vein occlusions (CRVOs) and hemi-CRVOs have clinically similar courses. They are associated with glaucoma and have a higher risk of anterior segment neovascularization and neovascular glaucoma. Branch retinal vein occlusions (BRVOs) and hemiretinal vein occlusions have a visible arterial-venous crossing where the occlusion occurs.
Macular edema may complicate both CRVOs and BRVOs. The first line of treatment for associated macular edema is anti-vascular endothelial growth factors (anti-VEGFs). Intravitreal corticosteroids, with the associated risk of glaucoma and cataract formation, have demonstrated efficacy. Also, laser photocoagulation surgery in BRVO has a potential role in treatment.
Optimizing control of systemic arterial hypertension, diabetes, serum lipid levels, and intraocular pressure (IOP) to control glaucoma are all important in the management of systemic risk factors, as is communicating end-organ damage to the primary care provider. (, , )
Recommendation Grading
Overview
Title
Retinal Vein Occlusions
Authoring Organization
American Academy of Ophthalmology
Publication Month/Year
February 1, 2020
Last Updated Month/Year
February 5, 2024
Supplemental Implementation Tools
Document Type
Guideline
External Publication Status
Published
Country of Publication
US
Document Objectives
Identify patients at risk for developing RVO. Encourage management of potential risk factors for both CRVO and BRVO, including optimizing systemic blood pressure and diabetes as well as control of glaucoma and ocular hypertension. Increase primary care awareness of the higher risk of cardiovascular and stroke complications in patients presenting with RVO. Monitor for signs of posterior or anterior segment neovascularization and neovascular glaucoma following all RVOs, because nonischemic can become ischemic. Treat patients who have vision loss or those at risk for vision loss after RVO. Minimize treatment side effects that might adversely impact vision and/or vision-related quality of life. Provide or refer the patient for visual rehabilitation services when permanent visual impairment results from the disease
Inclusion Criteria
Female, Male, Adult, Older adult
Health Care Settings
Ambulatory, Emergency care, Hospital, Outpatient
Intended Users
Nurse, nurse practitioner, physician, physician assistant
Scope
Diagnosis, Management
Diseases/Conditions (MeSH)
D012170 - Retinal Vein Occlusion, D014786 - Vision Disorders
Keywords
vision loss, retinal vein occlusion
Source Citation
Flaxel, C. J., Adelman, R. A., Bailey, S. T., Fawzi, A., Lim, J. I., Vemulakonda, G. A., & Ying, G. (2019). Retinal Vein Occlusions Preferred Practice Pattern®. Ophthalmology. doi:10.1016/j.ophtha.2019.09.029