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  BRANCH RETINAL VEIN OCCLUSION (BRVO)  
 

 

  • The clinical picture of branch retinal vein occlusion is retinal hemorrhages that are segmental in distribution.
  • The apex of the obstructed tributary vein almost always lies at an arteriovenous crossing. Usually some degree of pathologic arteriovenous nicking is present.
  • The occlusion is commonly located one or two disc diameters away from the optic disc. However, the occlusion may lie at a point near the disc edge or, less frequently, may involve one of the smaller, more peripheral tertiary or macular branches.

          

Etiology

  • Systemic Hypertension
  • History of cardio vascular disease
  • Increased cholesterol
  • History of glaucoma
  • High serum levels of a2 globulin

Ophthalmic Features

  • The clinical picture of branch retinal vein occlusion is retinal hemorrhages that are segmental in distribution.
  • The apex of the obstructed tributary vein almost always lies at an arteriovenous crossing. Usually some degree of pathologic arteriovenous nicking is present.
  • The occlusion is commonly located one or two disc diameters away from the optic disc. However, the occlusion may lie at a point near the disc edge or, less frequently, may involve one of the smaller, more peripheral tertiary or macular branches

                                

Treatment

  1. Medical treatment of branch retinal vein occlusion (BRVO) is not effective. In the past, anticoagulants, fibrinolytic agents, clofibrate capsules (Atromid-S), and carbogen inhalation have been used but without success.
  2. Intravitreal injection of Bevacizumab- Bevacizumab is a humanized recombinant monoclonal IgG antibody that binds and inhibits all VEGF isoforms. Several small retrospective and uncontrolled case series suggest that intravitreal bevacizumab at doses up to 2.5 mg are effective in improving visual acuity and reducing central macula thickness in eyes with macular edema secondary to BRVO. These results are often seen within 1 month of injection. However, most of the eyes will require additional injections to maintain the effects of bevacizumab.
  3. Intravitreal injection of Ranibizumab- A multicenter, prospective, phase III trial comparing intravitreal ranibizumab and sham injections demonstrated the value of VEGF inhibition in eyes with macular edema secondary to BRVO. In this study, eyes were randomized to monthly sham injections, 0.3 mg of ranibizumab and 0.5 mg of ranibizumab, for the first 6 months. Eyes were eligible for rescue laser at month 3 if the hemorrhages had sufficiently cleared to allow safe treatment and if the visual acuity remained at 20/40 or less and the central macular thickness was 250 µm or less.
  4. Intravitreal injection of  Triamcinolone - Intravitreal injection of triamcinolone has been used to treat macular edema of different etiologies because of its potent antipermeability and anti-inflammatory properties. A few cases of macular edema secondary to BRVO treated with an intravitreal triamcinolone injection have been reported. The exact dose remains unclear. Doses from 4 mg to 25 mg have been reported to be effective.
  5. Macular grid laser photocoagulation- Macular grid laser photocoagulation remains the criterion standard treatment of eyes with perfused macular edema secondary to BRVO
  6. Vitrectomy & arteriovenous decompression - Several surgeons have reported resolution of macular edema secondary to BRVO after vitrectomy with or without peeling of the internal limiting membrane.
    • Vitrectomy and posterior hyaloid separation improved the visual acuity in eyes with macular edema secondary to BRVO.