Treatment of Central Retinal Vein Occlusion :
Central retinal vein occlusion (CRVO)�is a common retinal vascular disorder. Central Retinal Vein Occlusion (CRVO) is caused by a blood clot in the CRV, which slows or stops blood from leaving the retina. The blockage reduces and ultimately stops blood circulation which results in retinal injury and loss of vision. Over time as the retina becomes starved for oxygenated blood, the eye responds by trying to make new blood vessels. These new blood vessels unfortunately can lead to severe complications, including retinal detachment and neovascular glaucoma, both of which may cause total blindness.
Causes
Central retinal vein obstruction has been associated with various systemic pathological conditions, although the exact cause and effect relationship has not been proven. Patients with Systemic vascular disease, Blood dyscrasias, Clotting disorders, Paraproteinemia and dysproteinemias, Vasculitis, are at increased risk for developing CRVO. CRVO was used to being considered as an "untreatable" disease and the "standard of care" management was simple observation with intervention only for complications like development of neovascular glaucoma. Unfortunately, the majority of eyes will not recover vision with this type of management and in the few eyes that do, the amount of vision recovered is very small. If vision is poor following CRVO, it is unlikely to get significantly better without treatment.
Diagnosis
Fluorescein angiography is the most useful test for the evaluation of retinal capillary nonperfusion, posterior segment neovascularization, and macular edema. Electroretinography (ERG) is another useful test to evaluate the functional status of the retina and to classify CRVO
TREATMENTS FOR CRVO
A clot dissolving medication, like the one used to treat a heart attack or stroke is used. The medication is directly injected into the branches of the Central Retinal Vein. This dissolves the clot and allows the retinal blood to circulate normally. This procedure is called as “Retinal Endovascular Surgery” or “REVS”. This is done as an out-patient procedure and takes about 40 minutes to complete.
Other treatments for CRVO include injection of the steroid triamcinolone acetonide into the eye (intravitreal triamcinolone acetonide injection, or IVTA) and radial optic neurotomy (RON) in which a stab incision is made in the optic nerve of the eye.
RON is also employed to treat CRVO and many eyes recover vision following the procedure.�
Risks
Some of the risks involved are:
- Ocular Neovascularization
- Macular edema
- Cellophane maculopathy and macular pucker
- Optic atrophy
- Glaucoma
- Optic Nerve drisun
Recovery
Neovascular complications and development of venous occlusions can develop after the procedure. Hence follow up care would be required for long periods of time. Patients with poor initial visual activity will be closely monitored every month for the first few months and spaced later on depending on the course of the disease.
