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      Branch Retinal Vein Occlusion: Pathogenesis, Visual Prognosis, and Treatment Modalities

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      Publication date (Electronic):
      Journal: Current Eye Research
      Publisher: Informa Healthcare
      Keywords: branch retinal vein occlusion, pathogenesis, risk factors, treatment, visual prognosis

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          Abstract

          In branch retinal vein occlusion (BRVO), abnormal arteriovenous crossing with vein compression, degenerative changes of the vessel wall and abnormal hematological factors constitute the primary mechanism of vessel occlusion. In general, BRVO has a good prognosis: 50–60% of eyes are reported to have a final visual acuity (VA) of 20/40 or better even without treatment. One important prognostic factor for final VA appears to be the initial VA. Grid laser photocoagulation is an established treatment for macular edema in a particular group of patients with BRVO, while promising results for this condition are shown by intravitreal application of steroids or new vascular endothelial growth factor inhibitors. Vitrectomy with or without arteriovenous sheathotomy combined with removal of the internal limiting membrane may improve vision in eyes with macular edema which are unresponsive to or ineligible for laser treatment.

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          The epidemiology of retinal vein occlusion: the Beaver Dam Eye Study.

          Barbara Klein, S Meuer, S Moss … (1999)
          To describe the prevalence and the 5-year incidence of retinal central and branch vein occlusion and associated risk factors. The Beaver Dam Eye Study (n = 4,926) is a population-based study in which retinal vein occlusions were detected at baseline (1988-1990) and at a 5-year follow-up examination (1993-1995) by grading of 30 degrees color fundus photographs. The prevalence and 5-year incidence of retinal branch vein occlusion were each 0.6%. The prevalence of retinal central vein occlusion was 0.1%, and the 5-year incidence was 0.2%. While adjusting for age, the prevalence of branch vein occlusion was associated with hypertension (odds ratio [OR] 5.42, 95% confidence interval [CI] 2.18, 13.47), diabetes mellitus (OR 2.43, 95% CI 1.04, 5.70), pulse pressure (OR 1.24 for 10 mm Hg, 95% CI 1.03, 1.48), ocular perfusion pressure (OR 2.09 for 10 mm Hg, 95% CI 1.45, 3.01), arteriovenous nicking (OR 16.75, 95% CI 7.33, 38.24), and focal arteriolar narrowing (OR 22.86, 95% CI 8.43, 62.03). The age-adjusted incidence of retinal branch vein occlusion was associated with current smoking (OR 4.43 95%, CI 1.53, 12.84) compared with nonsmokers and to focal arteriolar narrowing (OR 5.24, 95% CI 1.97, 13.94) at baseline. While controlling for age, the incidence of branch vein occlusion was not associated with serum lipid levels, body mass index, white blood cell count, alcohol consumption, aspirin use, glaucoma, intraocular pressure, or ocular hypertension. Retinal vein occlusion is infrequent in the population. These data suggest a strong association between retinal branch vein occlusion and retinal arteriolar changes. Data from larger populations are needed to further assess associations between risk factors and the incidence of retinal vein occlusions.
          Article 0 comments Cited 119 times – based on 0 reviews     Review now
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            Randomized controlled study of an intravitreous dexamethasone drug delivery system in patients with persistent macular edema.

            V Weinberg, M S Blumenkranz, Scott Whitcup … (2007)
            To evaluate a dexamethasone intravitreous drug delivery system (DDS) in patients with persistent (> or =90 days despite treatment) macular edema. This 6-month study randomized 315 patients with persistent macular edema with best-corrected visual acuity (BCVA) of 20/40 to 20/200 in the study eye to observation or a single treatment with dexamethasone DDS, 350 or 700 microg. Proportion of patients achieving a BCVA improvement of 10 or more letters or 15 or more letters, safety measures, change in fluorescein angiographic leakage, and central retinal thickness. At day 90 (primary end point), an improvement in BCVA of 10 letters or more was achieved by a greater proportion of patients treated with dexamethasone DDS, 700 microg (35%) or 350 microg (24%), than observed patients (13%; P<.001 vs 700-microg group; P = .04 vs 350-microg group); an improvement in BCVA of 15 letters or more was achieved in 18% of patients treated with dexamethasone DDS, 700 microg, vs 6% of observed patients (P = .006). Results were similar in patients with diabetic retinopathy, vein occlusion, or uveitis or Irvine-Gass syndrome. During 3 months of observation, 11% of treated patients and 2% of observed patients had intraocular pressure increases of 10 mm Hg or higher. In persistent macular edema, a single dexamethasone DDS treatment produced statistically significant BCVA improvements 90 days after treatment and was well tolerated for 180 days. Application to Clinical Practice Dexamethasone DDS, 700 microg, may have potential as a treatment for persistent macular edema.
            Article 0 comments Cited 109 times – based on 0 reviews     Review now
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              Argon laser photocoagulation for macular edema in branch vein occlusion. The Branch Vein Occlusion Study Group.

              (1984)
              The Branch Vein Occlusion Study is a multi-center, randomized, controlled clinical trial designed to answer several questions regarding the management of complications of branch vein occlusion. This report discusses the question, "Is argon laser photocoagulation useful in improving visual acuity in eyes with branch vein occlusion and macular edema reducing vision to 20/40 or worse?" One hundred thirty-nine eligible eyes were assigned randomly to either a treated or an untreated control group. Comparing treated patients to control patients (mean follow-up 3.1 years for all study eyes), the gain of at least two lines of visual acuity from baseline maintained for two consecutive visits was significantly greater in treated eyes (P = .00049, logrank test). Because of this improvement in visual acuity with argon laser photocoagulation of macular edema from branch vein occlusion, we recommend laser photocoagulation for patients with macular edema associated with branch vein occlusion who meet the eligibility criteria of this study.
              Article 0 comments Cited 101 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): Curr Eye Res
                Journal ID (publisher-id): ncer
                Title: Current Eye Research
                Publisher: Informa Healthcare
                ISSN (Print): 0271-3683
                ISSN (Electronic): 1460-2202
                Publication date (Print): February 2008
                Publication date (Electronic): 21 February 2008
                Volume: 33
                Issue: 2
                Pages: 111-131
                Affiliations
                Department of Ophthalmology, University Hospital, Palacky University, Olomouc, Czech Republic
                Department of Ophthalmology, University of Leipzig, Leipzig, Germany
                Author notes
                Correspondence: Jiri Rehak, Ph.D., M.D., Department of Ophthalmology, University Hospital, Palacky University, I. P. Pavlova 6, 775 20 Olomouc, Czech Republic. E-mail: jiri.rehak@ 123456ocniklinikaol.cz ; rehakj@ 123456fnol.cz
                Article
                DOI: 10.1080/02713680701851902
                PMC ID: 2430176
                PubMed ID: 18293182
                SO-VID: 5208eb63-ef6e-4231-aaf4-f7c0e314c130
                Copyright © © Informa Healthcare USA, Inc.
                License:

                This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 16 June 2007
                Date accepted : 08 December 2007
                Categories
                Subject: Mini-Review

                ScienceOpen disciplines: Vision sciences
                Keywords: visual prognosis,treatment,branch retinal vein occlusion,risk factors,pathogenesis
                Data availability:
                ScienceOpen disciplines: Vision sciences
                Keywords: visual prognosis, treatment, branch retinal vein occlusion, risk factors, pathogenesis

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