Current concepts in the management of central retinal vein occlusion

The results of the Central Vein Occlusion Study (CVOS) guide the management of macular edema and neovascularization. This study did not show that grid-pattern laser photocoagulation had a significant beneficial effect for the management of decreased visual acuity caused by perfused macular edema in eyes with central retinal vein occlusion (CRVO). Panretinal laser photocoagulation (PRP) was shown to be beneficial for eyes with at least 2 clock hours of iris neovascularization or any angle neovascularization. PRP has not been advocated as prophylaxis for ischemic eyes before the formation of neovascularization. Although treatment of the ocular consequences of CRVO may be guided by the CVOS data, management of the underlying cause of CRVO-the occluded vein itself-was not addressed in the study. Recently, several reports have suggested restoring venous outflow by 1) creating a laser-induced or surgically induced chorioretinal anastomosis, 2) administering recombinant tissue plasminogen activator (rt-PA), 3) cannulating the retinal vein transvitreally, or 4) transecting the posterior scleral ring.