Management of central retinal vein occlusion

Abstract

The management of central retinal vein occlusion (CRVO) is discussed briefly. Since the prognosis, complications, visual outcome and management of nonischemic and ischemic CRVO are very different, the first essential step in the management of CRVO is to determine which type of CRVO one is dealing with. The various parameters which help to differentiate the two types reliably are described briefly. In this connection, the most important thing to remember is that the conventional, very prevalent use of a 10-disc area of retinal capillary obliteration is an invalid parameter to differentiate ischemic from nonischemic CRVO, or to predict ocular neovascularization (NV). Ocular NV is a complication of ischemic CRVO only. Relevant issues about the natural history of CRVO are summarized; the natural history of the disease must not be mistaken for a beneficial effect of treatment. Various advocated modes of treatment of CRVO and their relative merits are discussed, particularly photocoagulation, which is widely advocated. Controversies with regard to various aspects of CRVO management are examined. Finally, it is noted that apart from routine systemic and hematologic evaluations, the vast majority of patients with CRVO do not need an extensive and expensive workup. In conclusion, in spite of enthusiastic claims of success for various therapies, the reality is that we currently have practically no proven safe and effective treatment for CRVO.