‘Simplified modified’ algorithm
In a paper published in 2016, Ashraf et al. developed what they termed “a simplified modified” treatment algorithm for CRVO based on review of large published studies of ranibizumab, aflibercept, corticosteroids, and laser therapy [Ashraf M, et al. Eye (Lond). 2016;30(40:505-514]. Their algorithm recommends initiating therapy with three monthly anti-VEGF injections.
Patients then are assessed with optical coherence tomography for changes in macular edema and categorized as early responders if they have fluid resolution, nonresponders, or partial responders. The early responders may be treated on an as-needed basis, but should be followed monthly through the first year. Thereafter, the follow-up interval can be extended gradually, but should not exceed three months.
According to the algorithm, partial responders should receive three more monthly anti-VEGF injections. Switching to another anti-VEGF agent or treatment with the dexamethasone implant (Ozurdex, Allergan) is recommended for partial responders with persistent fluid after six injections and for patients with no response after three injections.