Recent advances in understanding and managing retinal vein occlusions

Abstract

Retinal vein occlusions are the second most common form of retinal vascular disease. Previously, laser treatment for branch retinal vein occlusion and intravitreal triamcinolone acetonide for central retinal vein occlusion were the standard of care. Recent studies have demonstrated that anti-vascular endothelial growth factor (anti-VEGF) agents have a superior safety and efficacy profile for the treatment of both branch and central retinal vein occlusions. The use of wide-field fluorescein angiography has also allowed better visualization of the retinal periphery. Despite the better documentation of retinal non-perfusion, laser photocoagulation to the areas of non-perfusion does not seem to result in a reduction of macular edema or reduction in treatment burden and has been relegated to patients who develop rubeosis or neovascularization of the retina. More recently, several studies have demonstrated the use of a long-acting dexamethasone implant administered intravitreally or triamcinolone administered in the suprachoroidal space as a viable approach to treat retinal vein occlusion.

Comparative efficacy of bevacizumab, ranibizumab, and aflibercept for treatment of macular edema secondary to retinal vein occlusion: a systematic review and network meta-analysis

“…There are new VEGF inhibitors, biosimilars, and drug delivery systems for treating retinal vascular diseases in the pipeline. Conbercept is a new approved anti-VEGF drug for treating nAMD which is currently available only in China [52,53]. Conbercept can inhibit all VEGF isoforms and placenta growth factor and has the longer half-life (7 days) than the other anti-VEGF drugs which allows as-needed dosing regimen [54].…”

“…Brolucizumab is a humanized single-chain antibody fragment with high binding affinity. The phase 3 trials comparing brolucizumab to aflibercept in nAMD patients demonstrated non-inferiority in mean BCVA gain and safety profile between both drugs, and efficacy of brolucizumab could be maintained with 12-week dosing intervals after the loading phase through week 48 [52,53]. The biosimilar versions of ranibizumab (PF582) and bevacizumab (BCD021) have undergone clinical studies [54].…”

Assessment of Spontaneous Retinal Arterial Pulsations in Acute Central Retinal Vein Occlusions

“…It induces circulatory slow-down and upstream blood stasis appearing in the form of retinal hemorrhages [ 3 ]. CRVOs were classically separated into two clinical forms: ischemic CRVO (also possibly associated with cotton-wool spots) and nonischemic CRVO [ 4 ], the former being regarded as the more severe due to VEGF-mediated neovascular complications [ 5 , 6 ].…”

Effects of Common Thrombophilia Factor Mutations in Central Retinal Vein Occlusion

“…For instance, BRVO is 4 to 6 times more prevalent than CRVO (4) since the worldwide prevalence of RVO is 0.052% for any RVO, 0.042% for BRVO, and 0.008% for CRVO (5). CRVO in young adults is uncommon; only 10% to 15% of patients with CRVO are under 40 years of age (6). Furthermore, the occlusion patterns of BRVO and CRVO are entirely dissimilar.…”

“…Among the elements of Virchow's triad, the contribution of thrombogenesis or hypercoagulability of blood has not been as well investigated as the other 2 two factors. Therefore, the contribution of various hematological abnormalities to the etiology, pathogenicity, and treatment of CRVO remains unclear and there are contrasting clinical results (6)(7)(8)10).…”