Treatment of New Vessels and Macular Oedema secondary to Retinal Vein Occlusion

What is Retinal Vein Occlusion (RVO)?

Blood reaches the retina through a main artery and leaves through a main vein. Both of these have smaller branches which supply oxygen to the retina and drain de-oxygenated blood. A RVO occurs when the main vein or one of the small branches becomes blocked. When a vessel is blocked, blood and fluid can start to leak which may cause a sudden loss of vision. A RVO also compromises the blood flow and the amount of oxygen reaching the eye which can cause the growth of abnormal blood vessels and affect the function of the macula (portion of the retina responsible for central vision).

Types of Retinal Vein Occlusion (RVO)

Central Retinal Vein Occlusion (CRVO): Obstruction of the main vein formed from the four branches which drain blood from the retina.

Branch Retinal Vein Occlusion (BRVO): Obstruction a branch retinal vein(s) which drain specific areas of the retina.

What causes Retinal Vein Occlusion (RVO)?

It is not always known, however, blood tests and blood pressure checks may be requested to identify the cause. Various contributing factors include:

  • High blood pressure
  • Diabetes
  • Raised cholesterol levels
  • Smoking
  • Ageing

What is Macular Oedema (MO)?

Macular Oedema (MO) is the accumulation of fluid in the macula. The macula is the part of the retina which gives you sharp, straight-ahead vision, e.g. watching television or recognising faces. Macular oedema is usually caused by abnormal leakage from damaged blood vessels.

The accumulation of fluid causes the macula to swell which blurs and distorts vision.

The grey shadowed areas are where Oedema is present due to Central Retinal Vein Occlusion

How is Retinal Vein Occlusion diagnosed?

You will undergo Slit-Lamp Biomicroscopy and one or more of the following:

Swept-Source DRI Topcon Triton® OCT Scan

This new and advanced optical coherence tomography (OCT) imaging technology allows for improved identification of layers within the retina.

This technology enables Prof. Stanga to identify oedema (fluid) within or under the retina; objectively maps and measures retinal thickness, guides diagnosis and treatment, and monitors response.

Swept-Source DRI Topcon Triton® OCT Angiography Scan

This is a new OCT test which allows for the assessment of retinal blood flow in the central part of the retina in a non-invasive manner without the need of an injection of dye in the vein of your arm. This is an important diagnostic test for the early diagnosis of a change in or loss of blood supply.

Optos® Ultra-Widefield Retinal Scan

This diagnostic test allows for the assessment of blood flow from the central to the far periphery of the retina. Standard retinal cameras cannot capture detailed images of the peripheral retina. There is the need for an injection of dye in the vein of your arm. No radiation is used. These broad views of the retinal enable earlier diagnosis and tailored treatment planning and management of your condition 

How is Retinal Vein Occlusion treated?

Prof. Stanga will discuss with you available treatment options.

Treatment is tailored based on the stage of disease and may include one or more of the following: anti-VEGF,steroid injections, and Pascal® laser.

Laser treatment can be applied to either a localised area or the entire retina with the exception of the macula, or both.

If intraocular injections are required, Prof. Stanga will clean your eye and the surrounding skin with an antibacterial solution and numb the eye with anaesthetic drops. This is followed by an injection into the white of the eye. The injections may cause slight discomfort but most patients do not feel any pain.

The number of injections required varies according to the stage of the disease and individual patient response to treatment. The injections often start on a monthly basis and then are spread out as the condition improves.

If left untreated the vision can continue to deteriorate and treatment may no longer be an option.

Ensuring your blood pressure and cholesterol levels are well-controlled is an essential part of achieving an effective treatment and outcome.

Prof. Stanga and his team will discuss your diagnosis and treatment as well as give you all the necessary warnings.  If you notice any changes after treatment, you should call our 24/7 telephone line immediately on 020 7009 4400. If you cannot make contact with LVC staff on the above phone number, you should attend your local A&E straight away.

Please also read the Optical Coherence Tomography leaflet.
Please also read the Retinal Laser Treatment leaflet.
Please also read the Intravitreal Injections leaflet for further information on available drugs for injection, benefits and risks.
Prof. Stanga will go through the consent forms with you and explain in more detail.

Prof. Paulo E. Stanga
Consultant Ophthalmologist & Vitreoretinal Surgeon
Medical & Surgical Retina, Cataract Surgery, Eye Trauma
R&D New Therapies, Imaging, Laser & Surgical Tech

 

Retinal Vein Occlusion