Evaluation and management of branch retinal vein occlusion.


A branch retinal vein occlusion occurs when, because of hardening of the arteries, a branch retinal artery compresses a branch retinal vein causing blockage of the vein and decreased circulation in the distribution of that branch retinal vein. (see image) [note: the branch arteries are really arteriols and the branch veins are really veinules] There are several possible treatments for branch retinal vein occlusion including intravitreal injections, laser, and even surgery. Patients with BRVO lose vision for several reasons: poor circulation, hemorrhage and macular edema (swelling). There is no treatment, at the moment, to increase circulation or to remove hemorrhage. The macular edema, however, does respond well to intravitreal injections with Lucentis, Avastin, or steroids.


Monthly Lucentis therapy is also helpful in improving vision in patients with branch retinal vein occlusion and macular edema. Without treatment about 30 percent of have visual improvement. With treatment about 60 percent of patients have improved vision. Long term follow-up show that at 4 years, about half of the patients with branch retinal vein occlusion require continued treatment to maintain the visual benefit.


Eylea was approved for treatment of branch retinal vein occlusion in late 2014. It is administered as an intravitreal injection monthly initially and then the treatment interval can be extended.

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