Central Retinal Vein Occlusion. (CRVO)

"CRVO (Central Retinal Vein Occlusion) is a common retinal vascular episode occurring in aging people with systemic hypertension or open-angle glaucoma. In either case, a fundus photograph and OCT should be taken, not only to measure central retinal thickness (CRT) but also to assess the state of the optic disc to rule out primary open-angle glaucoma (POAG).

Management of CRVO requires a complete cardiovascular check-up and blood count to detect blood hyperviscosity, which makes circulation sluggish and predisposes the patient to venous thrombosis. The mainstay of treatment is to deliver intravitreal anti-VEGF injections (Eylea, Lucentis, etc.) forthwith to minimize macular edema and improve vision.

After three consecutive injections at monthly intervals, an FFA (Fundus Fluorescein Angiogram) should be performed to detect retinal ischemia. If present, pan-retinal photocoagulation (PRP) with laser should be instituted immediately to save the eye from neovascular glaucoma (NVG). Once NVG sets in, every effort should be made to cause regression of the new vessels responsible for this visual catastrophe. This includes PRP with laser if the cornea is clear, cryocoagulation of the peripheral retina if the cornea is edematous, or diode laser therapy to control high intraocular pressure (IOP). An AGV (Ahmed Glaucoma Valve) or a similar device with a silicone tube may be inserted in the eye to control IOP and preserve residual vision.

'Waste not the time, let not the advantage slip.' — William Shakespeare."