Expert panels reviewing the available scientific evidence have developed algorithms that provide step-by-step recommendations for evaluation and management of macular edema secondary to RVO.
According to algorithms published in 2015 by a group of 11 Canadian retinal specialists [Berger AR, et al. Ophthalmologica. 2015;234(1):6-25], initial treatment for branch retinal vein occlusion (BRVO) is guided by the presence or absence of neovascularization and macular edema, while macular edema is considered for central retinal vein occlusion (CRVO) patients.
The panel recommended initial laser therapy for patients with BRVO and neovascularization with adjunctive use of an anti-VEGF agent if vitreous hemorrhage is also present. Initiating treatment with monthly anti-VEGF injections was recommended for eyes with macular edema and vision loss.
When patients start anti-VEGF therapy, the algorithm recommends evaluating response after three monthly injections. It proposes the use of intravitreal corticosteroids as second-line treatment for suboptimal responders with CRVO and grid laser for BRVO patients.