Central Retinal Vein Occlusion

Management of CRVO

Management of CRVO still remains uncertain and highly controversial. Over the years many treatments have been advocated enthusiastically and success claimed but none has stood the test of time. These include anticoagulants, hemodilution, corticosteroids, acetazolamide, fibrinolytic agents, low molecular weight dextran infusion, carbon dioxide inhalation, vasodilators, hyperbaric oxygen, ocular hypotensive therapy, surgical decompression of CRVO, laser-induced chorioretinal anastomoses, photocoagulation, and a host of others.

The most important consideration when evaluating a therapy for any disease is to determine whether the therapy is based on incontrovertible scientific facts. Treatments without such a logical foundation prove not only useless but also sometimes harmful. Recently I have reviewed the various advocated modes of treatment in CRVO and their scientific validity.⁶ This review revealed that, unfortunately, most of the advocated treatments lack an incontrovertible scientific basis. Successes and beneficial effects claimed for many therapies in most cases simply represent the natural history of the disease, and that basic fact has been ignored in almost all the studies.

The fact that I would like to stress at the outset is that ischemic CRVO is a different, far more serious and potentially blinding disease than non-ischemic CRVO, and it requires wholly different management. Therefore, we must at first know which type of CRVO we are dealing with, and that makes differentiation of two types of CRVO the first essential step in the management of CRVO.

Following is a brief account of the major therapies advocated and tried from time to time. The main treatments can be divided into three categories: (A) medical, (B) surgical and (C) photocoagulation.