Limited surgical options for RVO

None of the current treatment procedures available have been found to effectively prevent or retrieve visual loss after retinal vein occlusion (RVO), said Francesco Boscia MD, Italy, at the 15th EURETINA Congress in Nice.

“The evidence we have to date results mostly from small, non-randomised studies. The differences in follow-up, initial treatment times, ischaemic and non-ischaemic status and duration of RVOs prevent accurate comparisons between case series and limit the conclusions that can be drawn,” he said.

Nevertheless, the positive news is that the treatment options for RVO are dramatically expanding with the introduction of dexamethasone implants, as well as ranibizumab and aflibercept treatments offering new hope to patients, he added.

“While new treatments are clearly welcome, we need to remember that steroids or anti-VEGF therapy do not alter the anatomic blockage in the retinal vein, so there is a necessity for ongoing treatment. What we really need are therapies that definitely resolve macular oedema and primarily address the vein blockage,” he said.

Current surgical treatments for RVO include pars plana vitrectomy (PPV) with or without internal limiting membrane (ILM) peeling, sheathotomy, surgically-induced retino-choroidal anastomosis, radial optic neurotomy and direct recombinant tissue plasminogen activator.

All of these procedures have their benefits and drawbacks, said Dr Boscia. Retino-choroidal venous anastomosis, for instance, improves retinal outflow and reduces macular oedema and may improve vision in non-ischaemic central RVO. However, the success rate is low, and the complication rate can be quite high, including choroidal and vitreous haemorrhages and choroidal neovascularisation at the anastomosis site.