Central Retinal Vein Occlusion
Last updated: February 6th, 2022
Summary of Evidence
Treatment of Macular Edema
Intravitreal anti-VEGF injections
Intravitreal ranibizumab provides rapid, effective treatment for macular oedema following CRVO at 6 months.(CRUISE, 2010). {Brown DM, Campochiaro PA, Singh RP, Li Z, Gray S, Saroj N, Rundle AC, Rubio RG, Murahashi WY; CRUISE Investigators. Ranibizumab for macular edema following central retinal vein occlusion: six-month primary end point results of a phase III study. Ophthalmology. 2010 Jun;117(6):1124-1133.e1.}
Intravitreal Aflibercept provided significant functional and anatomic benefits at 1 year vs sham in patients with Macular oedema secondary to CRVO, with improvements after 6 monthly doses maintained at 1 year on a PRN dosing.(GALILEO, 2014). {Korobelnik JF, Holz FG, Roider J, Ogura Y, Simader C, Schmidt-Erfurth U, Lorenz K, Honda M, Vitti R, Berliner AJ, Hiemeyer F, Stemper B, Zeitz O, Sandbrink R; GALILEO Study Group. Intravitreal Aflibercept Injection for Macular Edema Resulting from Central Retinal Vein Occlusion: One-Year Results of the Phase 3 GALILEO Study. Ophthalmology. 2014 Jan;121(1):202-208.}
Intravitreal Bevacizumab was non-inferior to Aflibercept in 6-month visual outcomes in macular oedema secondary to central/hemi-RVO.(SCORE2, 2017). {Scott IU, VanVeldhuisen PC, Ip MS, Blodi BA, Oden NL, Awh CC, Kunimoto DY, Marcus DM, Wroblewski JJ, King J; SCORE2 Investigator Group. Effect of Bevacizumab vs Aflibercept on Visual Acuity Among Patients With Macular Edema Due to Central Retinal Vein Occlusion: The SCORE2 Randomized Clinical Trial. JAMA. 2017 May 23;317(20):2072-2087.}
Mean change in vision were similar with Aflibercept and Ranibizumab in macular oedema due to CRVO. Vision change with Bevacizumab vs Ranibizumab was inconclusive.(LEAVO, 2019). {Hykin P, Prevost AT, Vasconcelos JC, Murphy C, Kelly J, Ramu J, Hounsome B, Yang Y, Harding SP, Lotery A, Chakravarthy U, Sivaprasad S; LEAVO Study Group. Clinical Effectiveness of Intravitreal Therapy With Ranibizumab vs Aflibercept vs Bevacizumab for Macular Edema Secondary to Central Retinal Vein Occlusion: A Randomized Clinical Trial. JAMA Ophthalmol. 2019 Nov 1;137(11):1256-1264.}
Laser Photocoagulation (Macular laser)
Macular grid photocoagulation is not recommended for macular oedema secondary to CRVO.(CVOS, 1995). {Evaluation of grid pattern photocoagulation for macular edema in central vein occlusion. The Central Vein Occlusion Study Group M report. Ophthalmology. 1995 Oct;102(10):1425-33.}
Intravitreal triamcinolone
Intravitreal triamcinolone is superior to observation for treating macular edema secondary to CRVO.(SCORE, 2009). {Ip MS, Scott IU, VanVeldhuisen PC, Oden NL, Blodi BA, Fisher M, Singerman LJ, Tolentino M, Chan CK, Gonzalez VH; SCORE Study Research Group. A randomized trial comparing the efficacy and safety of intravitreal triamcinolone with observation to treat vision loss associated with macular edema secondary to central retinal vein occlusion: the Standard Care vs Corticosteroid for Retinal Vein Occlusion (SCORE) study report 5. Arch Ophthalmol. 2009 Sep;127(9):1101-14.}
Treatment of Neovascularization
Laser panretinal photocoagulation
Prophylactic PRP does not totally prevent iris/angle neovascularisation (CVOS definition). The study authors recommend careful close observation initially and prompt PRP of eyes in which iris/angle neovascularisation develops.(CVOS, 1995). {A randomized clinical trial of early panretinal photocoagulation for ischemic central vein occlusion. The Central Vein Occlusion Study Group N report. Ophthalmology. 1995 Oct;102(10):1434-44. PMID: 9097789.}
Responses