[Retinal vein occlusion management algorithm. Part 2. Macular edema].

Area of Science:

• Ophthalmology
• Retinal Diseases
• Vascular Disorders

Context:

• Macular edema (ME) is a primary complication of retinal vein occlusion (RVO).
• Central retinal vein occlusion (CRVO) involving the main trunk leads to ME in all cases.
• Visual acuity (VA) and optical coherence tomography (OCT) are key diagnostic and prognostic indicators.

Purpose:

• To establish evidence-based recommendations for managing macular edema in retinal vein occlusion.
• To define optimal treatment-free follow-up durations and criteria for intervention.
• To outline current therapeutic strategies, including intravitreal injections and laser photocoagulation.

Summary:

• A 3-month observation period is recommended for nonischemic CRVO with ME and VA ≥0.5, with treatment initiated if no improvement occurs.
• Immediate treatment is indicated for cystic ME with VA <0.5.
• Intravitreal corticosteroids (Ozurdex) and anti-VEGF agents (ranibizumab, aflibercept) are first-line treatments for CRVO-associated ME, supplemented by laser for persistent cases.
• Modified grid laser photocoagulation is the only recommended laser technique, and anti-VEGF regimens require adjustment for branch RVO (BRVO).

Impact:

• This approach aims to optimize visual outcomes by avoiding unnecessary treatments and intervening promptly when necessary.
• It provides a clear management pathway for clinicians, potentially improving patient prognosis.
• Highlights the importance of regular OCT monitoring for treatment efficacy assessment.