Management of Central Retinal Vein Occlusion

Abstract

Central retinal vein occlusion (CRVO) is a major retinal vascular disorder and an important cause of visual impairment, particularly in older adults. Visual loss is mainly related to macular edema, retinal ischemia, and neovascular complications. Management primarily focuses on treating macular edema, monitoring retinal perfusion, preventing neovascular complications, and controlling associated systemic risk factors. Intravitreal anti-vascular endothelial growth factor (anti-VEGF) agents represent the current first-line therapy for CRVO-related macular edema. Ranibizumab and aflibercept have demonstrated substantial improvements in visual acuity and retinal thickness, while newer treatment options, including aflibercept 8 mg and faricimab, may provide effective disease control with the potential for extended treatment intervals. Intravitreal corticosteroids, including triamcinolone acetonide and dexamethasone implants, remain useful alternatives in selected patients, although their use is limited by the risks of intraocular pressure elevation and cataract progression. Macular grid laser has no established role in CRVO-related macular edema. In ischemic CRVO, close surveillance is essential for early detection of neovascularization, with panretinal photocoagulation indicated after neovascularization develops. Persistent vitreous hemorrhage preventing adequate laser treatment may require pars plana vitrectomy with intraoperative panretinal photocoagulation. Prognosis is strongly influenced by retinal perfusion status, baseline visual acuity, and the severity of macular damage, with ischemic CRVO generally associated with substantially poorer visual outcomes.