Retinal vein occlusion

Macular oedema is by far the most frequent cause of visual loss in retinal vein occlusion (RVO), and sequellae such as cystic degeneration, macular hole, epiretinal membrane and macular atrophy can be devastating, Francesco Bandello MD, FEBO, Vita-Salute University, Milan, Italy, told delegates at the 15th EURETINA Congress in Nice.

Dr Bandello was speaking during a main session on RVO. His presentation focused on the indications for anti-VEGF treatment.

“Both the BRAVO and the CRUISE studies offered unequivocal evidence that early treatment with anti-VEGF gives the best chance of visual recovery for patients with macular oedema,” he said. “But it’s also important to remember these studies show that later treatment, for example six months after onset, remains worthwhile.”

Additionally, Dr Bandello advocated an aggressive approach to treatment, which he considers superior to PRN treatment. He reminded delegates that, although there is no large-scale hard data for bevacizumab, “I think we can assume that this molecule is non-inferior to ranibizumab for this indication”.

What about macular ischaemia? Is this a contraindication for anti-VEGF treatment in RVO? Dr Bandello does not think so.
“An article published by Campochiaro et al in Ophthalmology in 2013 showed that patients treated with ranibizumab had less retinal non-perfusion compared to sham-treated patients,” he said, so physicians should not consider ischemia to be a contraindication.

Dr Bandello also discussed the results of his team’s recent investigations of retinal vasodilation using the dynamic vessel analyser. These suggest that anti-VEGF treament might have a beneficial effect on vascular functionality.