Management of retinal vein occlusions

Research output: Contribution to journalArticle

Abstract

Macular edema (ME) is the most common cause of reduced vision in patients with retinal vein occlusions (RVOs). The primary cause for ME was previously thought to be transudation due to increased venous pressure caused by obstructed outflow, but we now have a greater understanding of the critical role of retinal ischemia leading to release of vascular endothelial growth factor (VEGF). An early pilot study of ranibizumab conducted at the Wilmer Eye Institute in patients with ME due to either branch or central RVOs (BRVO or CRVO) showed a rapid and robust decrease in excess central retinal thickening and a corresponding rapid and robust increase in visual acuity. There was a negative correlation between aqueous VEGF level at baseline and visual outcome, indicating that particularly high VEGF levels were a disadvantage. These results led to pivotal, randomized, controlled trials in patients with BRVO (BRAVO [Efficacy and Safety of Ranibizumab Injection in Patients with ME Secondary to BRVO] study) and CRVO (CRUISE [Efficacy and Safety of Ranibizumab Injection in Patients with ME Secondary to CRVO] study), which have demonstrated impressive benefits over the course of 6 months. Although the long-term effects of ranibizumab are not completely established, continued follow-up for 2 years in patients enrolled in the initial pilot trial suggest that as-needed ranibizumab results in complete and partial maintenance of benefits in patients with BRVO or CRVO, respectively. Considering the recent approval of ranibizumab for treatment of RVO by the US Food and Drug Administration, new recommendations for management of RVO are offered.

Original languageEnglish (US)
Pages (from-to)42-47
Number of pages6
JournalJohns Hopkins Advanced Studies in Ophthalmology
Volume7
Issue number2
StatePublished - Dec 1 2010

ASJC Scopus subject areas

  • Ophthalmology

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