Interventions for Branch Retinal Vein Occlusion: An Evidence-Based Systematic Review
Presented at: Association for Research in Vision and Ophthalmology Annual Meeting, April 2006, Fort Lauderdale, Florida.
Received 16 May 2006; accepted 8 January 2007. published online 31 March 2007.
Topic
To assess the evidence on interventions to improve visual acuity (VA) and to treat macular edema and/or neovascularization secondary to branch retinal vein occlusion (BRVO).
Clinical Relevance
Branch retinal vein occlusion is the second most common retinal vascular disease.
Methods/Literature Reviewed
English and non-English articles were retrieved using a keyword search of Medline (1966 onwards), Embase, the Cochrane Collaboration, the National Institute of Health Clinical Trials Database, and the Association for Research in Vision and Ophthalmology Annual Meeting Abstract Database (2003–2005). This was supplemented by hand searching references of review articles. Two investigators independently identified all randomized clinical trials (RCTs) with more than 3 months’ follow-up.
Results
From 4332 citations retrieved, 12 RCTs were identified. There were 5 RCTs on laser photocoagulation. Grid macular laser photocoagulation was effective in improving VA in 1 large multicenter RCT, the Branch Vein Occlusion Study (BVOS), but 2 smaller RCTs found no significant difference. The BVOS showed that scatter retinal laser photocoagulation was effective in preventing neovascularization and vitreous hemorrhage in patients with neovascularization, but a subsequent RCT found no significant effect. Randomized clinical trials evaluating intravitreal steroids (n = 2), hemodilution (n = 3), ticlopidine (n = 1), and troxerutin (n = 1) showed limited or no benefit.
Conclusions
There is limited level I evidence for any interventions for BRVO. The BVOS showed that macular grid laser photocoagulation is an effective treatment for macular edema and improves vision in eyes with VA of 20/40 to 20/200, and that scatter laser photocoagulation can effectively treat neovascularization. The effectiveness of many new treatments is unsupported by current evidence.
1Centre for Eye Research Australia, University of Melbourne, Melbourne, Australia.
2Royal Victorian Eye and Ear Hospital, Melbourne, Australia.
3Department of Community, Occupational, and Family Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
4Singapore Eye Research Institute, National University of Singapore, Singapore.
Correspondence to Tien Y. Wong, MD, PhD, Centre for Eye Research Australia, University of Melbourne, 32 Gisborne Street, East Melbourne VIC 3002, Australia.
Manuscript no. 2006-534.
The authors have no proprietary interests related to the article.
Funding was provided by the Science Technology and Innovation Grant, Victoria State Government, Melbourne, Australia, and Sylvia and Charles Viertel Clinical Investigator Award, Sylvia and Charles Viertel Charitable Foundation, Melbourne, Australia (TYW).
ABSTRACT