Branch retinal vein obstruction

Branch retinal vein obstruction (BRVO) is a common retinal vascular disease of the elderly. It is caused by the occlusion of one of the branches of central retinal vein.^[1]

Epidemiology

BRVO is 3 times more common than CRVO. Usual age of onset is 60-70 years.

Risk factors

Studies have identified the following abnormalities as risk factors for the development of BRVO:

hypertension

cardiovascular disease

obesity

glaucoma

Diabetes mellitus was not a major independent risk factor.

Manifestations

Patients with BRVO usually complain of sudden onset of blurred vision or a central visual field defect. The eye examination findings of acute BRVO include superficial hemorrhages, retinal edema, and often cotton-wool spots in a sector of retina drained by the affected vein.

Diagnosis and testing

The diagnosis of BRVO is made clinically by finding retinal hemorrhages in the distribution of an obstructed retinal vein.

Fluorescein angiography is a helpful adjunct for the guidance for the treatment. Optical coherence tomography is another adjunctive test in BRVO. Macular edema is commonly seen in BRVO in OCT exams.

Treatment

Several options exist for the treatment of BRVO. These treatments aim for the two of the most significant complications of BRVO, namely macular edema and neovascularization.^[1]

Laser treatment of the macular area to reduce macular edema is indicated in patients who have 20/40 or worse vision and did not spontaneously improve for at least 3 months after the development of the vein occlusion.
The second indication of laser treatment is in case of neovascularization. Retinal photocoagulation is applied to the involved retina to cover the entire involved segment.
Triamcinolone: may be injected into the vitreous cavity to treat macular edema at the price of elevated intraocular pressure and development of cataract.
Anti-VEGF drugs such as Avastin are being evaluated.
Surgery is employed occasionally for longstanding vitreous hemorrhage and other serious complications.

References

^ ^a ^b Basic and clinical science course (2011–2012). Retina and vitreous. American Academy of Ophthalmology. pp. 150–154. ISBN 978-1615251193.{{cite book}}: CS1 maint: date format (link)

[ao-1] Basic and clinical science course (2011–2012). Retina and vitreous. American Academy of Ophthalmology. pp. 150–154. ISBN 978-1615251193.{{cite book}}: CS1 maint: date format (link)

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