.
 Section 6 Medical Management
Referral for medical investigation and treatment
IT IS THE RESPONSIBILITY OF THE OPHTHALMOLOGICAL TEAM TO ENSURE MEDICAL INVESTIGATION AND TREATMENT IS INITIATED ON DIAGNOSIS OF RETINAL VEIN OCCLUSION.
 

Recommended investigations for patients with retinal vein occlusion are listed in
Table 2. It is the responsibility of the diagnosing physician or ophthalmologist to:
 

  • Investigate and interpret results.
  • Refer the patient for appropriate medical advice with urgency according

    • to the severity of underlying risk factor(s).
  • Ensure that specialists in the relevant field should manage the rarer

    • causes of retinal vein occlusion.
  • Ensure that initiation of medical management occurs within 2 months of

    • diagnosis.
The importance of detecting and treating underlying medical conditions lies in the
need to prevent further non-ocular target organ damage, as well as to prevent
recurrence of venous occlusion particularly in the fellow eye.40 Two long-term followup studies of patients with retinal vascular disease (retinal vein occlusion and retinal arterial occlusion) demonstrate excess cardiovascular morbidity, mortality from stroke, and myocardial infarction over a ten-year period.41,42
Therefore, medical management should be targeted at three areas.
 

6.1 Reverse retinal vein occlusion
This is applicable in a limited number of cases. Patients with ‘incipient’ retinal
vein occlusion (consisting of the presence of dilated retinal veins and few
widely scattered haemorrhages without any macular oedema in patients who
are either asymptomatic or have transient episodes of blurring in the affected
eye and may have slight increase in retinal circulation time on fluorescein
angiography)43 should have medical investigation for underlying systemic risk
factors and treatment urgently as there is the potential to prevent progression,
or to reverse the existing occlusion. Anti-platelet agents may be of benefit. In
exceptional circumstances other measures may be considered, but there is only
anecdotal evidence of their benefit, and they may be potentially harmful.
 

The medical therapies explored to improve retinal venous flow include44: -
 

Anti-coagulants, heparin
Fibrinolytic agents: streptokinase, tissue plasminogen activator (intravitreal or
systemic)
Anti-platelet drugs: aspirin, prostacyclin, ticlopidine
 

These would seem to be logical treatments, but results from trials using
heparin, streptokinase and warfarin have been disappointing with limited
evidence of benefit owing to adverse effects of retinal and vitreous
haemorrhage.
 

Haemodilution
The effects of haemodilution have been inconsistent in completed control trials
in RVO although results from further trials are awaited.
 
Introduction Methods used Risk factors CRVO
BRVO Medical treatment Cardiovascular problems Young patient
References. Tables Main index Main page.
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