Retinal vein occlusion (RVO) is an interruption of the normal venous drainage from the retinal tissue. Either the central vein or one of its branches can become occluded.
Hypertension, diabetes mellitus, atherosclerosis, and glaucoma are major risk factors for the development of central retinal vein occlusion (CRVO) or branch retinal vein occlusion (BRVO) in older patients.
RVO frequently presents as sudden, painless, unilateral vision loss. Most affected patients are ages >65 years.
Hypercoagulability and vasculitis are important risk factors for the development of CRVO or BRVO in younger patients.
Treatment is focused on vision-threatening complications such as macular edema and neovascularization. For an uncomplicated retinal vein occlusion, whether it is ischemic or nonischemic, management consists of close monitoring to detect complications and treatment of underlying risk factors.
Several randomized controlled trials support the use of vascular endothelial growth factor (VEGF) inhibitors and intravitreal corticosteroids for the treatment of macular edema in CRVO and BRVO.
Retinal vein occlusion (RVO) is an interruption of the normal venous drainage from the retinal tissue. Either the central vein (CRVO) or one of its branches (BRVO) can become occluded. Uncommonly, the occlusion can occur in a vein that drains half of the retina. This is referred to as a hemiretinal vein occlusion (HRVO). Characteristically, in the retina proximal to the occlusion, the affected venous system is tortuous and dilated, and there are several intraretinal hemorrhages and retinal edema. Retinal vein occlusions are usually painless, sudden, and unilateral causes of vision loss.
History and exam
Key diagnostic factors
- sudden, painless vision loss
- optic nerve head edema
- intraretinal hemorrhage
- venous tortuosity and dilation
- collateral vessel formation
Other diagnostic factors
- age >65 years
- vitreous hemorrhage
- macular edema
- painful, red eye
- visual acuity
- relative afferent pupillary defect
- elevated intraocular pressure
- systemic hypertension
- diabetes mellitus
- history of smoking
- cardiovascular disease
- increased body mass index at 20 years of age
- increased serum alpha-2 globulin
- short axial length
- activated protein C resistance
- factor V Leiden
- hypercoagulable state
- protein S deficiency
- antithrombin III deficiency
- age >65 years
1st investigations to order
- fluorescein angiogram for confirmation of diagnosis
Investigations to consider
- fluorescein angiogram for assessment of complications
- optical coherence tomography
CRVO with macular edema
CRVO with neovascularization
BRVO or HRVO: uncomplicated
BRVO or HRVO with macular edema
BRVO or HRVO with neovascularization
- Ischemic optic neuropathy
- Retinal detachment (RD)
- Choroidal neovascularization (CNV)
- Retinal vein occlusion (RVO) guidelines
- Retinal vein occlusions preferred practices pattern
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