The Massachusetts Eye and Ear Infirmary Illustrated Manual of Ophthalmology by Peter K. Kaiser & Neil J. Friedman & Pineda II Roberto II

Author:Peter K. Kaiser & Neil J. Friedman & Pineda II, Roberto, II [Kaiser, Peter K.]
Language: eng
Format: epub
ISBN: 9781455776443
Publisher: Elsevier Health Sciences
Published: 2014-02-28T00:00:00+00:00

Management

• Panretinal laser photocoagulation (PRP) (500 μm spots) when rubeosis (≥ 2 clock hours of iris or any angle neovascularization), disc/retinal neovascularization, or neovascular glaucoma develops; no benefit to prophylactic PRP (Central Retinal Vein Occlusion Study-CVOS conclusion).

• Currently the best therapy for macular edema due to CRVO is intravitreal anti-VEGF agents such as 0.5 mg ranibizumab [Lucentis] (CRUISE Study result), 2.0 mg aflibercept [Eylea] (COPERNICUS / GALILEO Study result), or 1.25 mg bevacizumab [Avastin] monthly for the first 6 months, with as-needed treatment thereafter.

• Second-line intravitreal steroid therapy consists of intravitreal 4 mg triamcinolone acetonide [Triessence] (SCORE Study result) and the sustained-release biodegradable dexamethasone implant [Ozurdex].

• Focal laser photocoagulation decreases macular edema, but has no effect on visual acuity (CVOS conclusion), although there was a trend in the CVOS for focal laser to work in younger patients.

• Creation of chorioretinal venous anastomosis by intentional rupture of Bruch’s membrane with high-intensity laser photocoagulation or surgical blade reportedly successful in ⅓ of cases, but still experimental. Intravenous injection of tissue plasminogen activator (tPA) into the lumen of the central retinal vein is also experimental.

• May require treatment of increased intraocular pressure (see Primary Open-Angle Glaucoma section in Chapter 11).

• Discontinue oral contraceptives and change diuretics to an alternate antihypertensive.

• Consider aspirin (80–325 mg po qd).

• Treat underlying medical condition.

Download

Copyright Disclaimer:
This site does not store any files on its server. We only index and link to content provided by other sites. Please contact the content providers to delete copyright contents if any and email us, we'll remove relevant links or contents immediately.