Retinal vein occlusion ( RVO)
RVO (Retinal Vein Occlusion) occurs when a blood vessel in the
retina becomes blocked. This blockage can cause fluid to leak into
the macula, which can cause vision loss or blurring.
There are 2 main types:
Central Retinal Vein Occlusion (CRVO) : less common
Branch Retinal Vein Occlusion (BRVO) : more common
Age > 50 years
High blood pressure,
History of blood clot
High cholesterol level
Other systemic disorders like infections
Yes, young people with above mentioned high risk factors can
Additionally people with clotting disorders, some anti-bodies
related immune disorders or with high homocysteine levels
can get this disease.
Symptoms of retinal vascular occlusion may include:
Loss of vision
There are many reasons which can affect your vision.
a) Macular Edema (swelling ) : occurs when fluid leaks
into macula as a result of blocked retinal vein.
b) Haemorrhage ( blood spots on retina) : due to sudden
rise in pressure in the capillaries causing blood to
escape from the capillaries i.e. bleeding
c) Ischaemia ( less / no oxygen supply) : If damage to
retinal capillaries at the time of the vein occlusion is
severe, they may become permanently damaged and
- While there is currently no cure for reduced eyesight caused by
retinal vein occlusion, treatment is available to preserve it.
There are several types of treatment used in retinal vein
occlusions. These include:
Vitreous surgery ( Vitrectomy )
a) Clinical diagnosis : After routine ophthalmic examination
with indirect ophthalmoscope
b) Opinion & treatment of systemic diseases from your
c) If you have associated glaucoma, you will be treated
simultaneously for that also.
d) After systemic clearance from the physician , he will evaluate
you with various ophthalmic investigations like
– Fundus photo
– FFA ( Fundus fluorescein angiography)
– OCT ( Optical Coherence Tomography)
Based on above investigations, your doctor will decide what is
the right course of treatment for you. It can be only lasers or
only injection or combination of both.
A) Intra-vitreal Injections : For macular edema . After initial
treatment, few patients might need few more injections
in coming 1-2 years to preserve your vision.
There are various options of injections. Multiple factors
decide which injection you will be recommended.
I: Intra-vitreal injections of Anti-VEGF drugs : First drug of
Types of anti-VEGF :
a) Avastin : Bevacizumab
Not FDA approved
Primarily used in treatment of colon cancer
Used world wide for retinal disorders.
b) Accenterix : Ranibizumab
World wide studies have been done regarding its
safety & efficacy
c) Razumab : Accenterix
Biosimilar : A biopharmaceutical drug designed to have
active properties similar to one that has previously been
licensed & approved.
DCGI approved in 2015
Phase 3 trial in Indian patients only
No world wide trials
d) Eylea : Aflibercept
Multicentric trials done
II: Intra-vitreal injections of Corticosteroids : Other option .
There is risk of increase in eye pressure in 30% patients after
this injection, but, that increase in eye pressure can be
managed by drops.
Options of corticosteroid injections are :
a) Triamcinolone acetate : Stays in eye for around 6 weeks
After injection , your vision becomes cloudy because of
milky consistency of injection. So, you will be advised to rest
with 2 pillows for early settling down of injection. With this
molecule there are more chances of increase in ocular
b) Ozurdex / Dexamaethasone implant : It is a bio-
degradable cylindrical implant injected into your eye. It
slowly release drug over a period of 3-3.5 months. Initially
you may see a cylinder in your visual field, which gradually
reduces in size & finally disappears.
B) Lasers : if blood flow is not proper & sufficient as
diagnosed on FFA
C) Vitreous surgery : If complications like bleeding or pull
( traction) over retina develops.
In vitreous surgery, vitreous gel, which is pulling on the
retina, is removed from the eye and replaced with a gas
bubble or oil to keep the retina in place. Your body’s own
fluids will gradually replace a gas bubble. An oil bubble will
need to be removed from the eye at a later date with
another surgical procedure. After surgery, your
ophthalmologist will recommend that you keep your head in
special positions for a specific period of time.
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