1516hrs: Venous Occlusive Disease (David Albiani)
/Moved his talk to the end and skipped the pathophysiology in the interest of time. Quick run through of vascular conditions including malignant hypertension, ocular ischemia, etc. Classification based on ischmic or not and anatomic location. Then runs through some cases.
Case 1:
45 yo M, 6/120 vision with blood and thunder macula. Lots of blockage with late leakage on FA. Typical mountain on OCT. Ischemic.
Case 2:
41 yo M, less extensive heme, just a bit of leakage, milder macular edema. Non-ischemic.
Evaluation includes detailed eye exam, BP, glucose, HgA1C, etc
Complications can occur early or late.
Historically, much has been tried over many years. In past, COVS was basis of a lot of treatment and BVOS study. COVS suggested only treating ischemic and BVOS waiting 3 months for resolution before grid treatment.
Another historical failure was laser chorioretinal anastamosis. But kenalog and anti-VEGF began to appear.
Radial optic neurotomy, don’t do it! Published study 208.
Biggest advance was in 2009 with SCORE Reprot No 5. Intravtreal triamcinolone led to average 15 letter improvement on ETDRS chart.
Ozurdex also did an RCT comparing single Tx. Appearing in the April 2010 Ophthalmology.
CRUISE study looking at Lucentis for CRVO to observation in a RCT. Also did a sister study on BRVO. Both studies though excluded patients who had brisk afferent pupillary defects which may be a weakness of this study.
Another study looking at Avastin and grid laser combo, in Retina.
Study of VEFG Trap that Dr Albiani involved in showing 200X more biologic activity at 1 month post injection compared with Avastin. Presents a couple of case studies from this series. Bearing in mind potential bias as investigator cherry picking cases.