58.1General Considerations

A retinal vein is occluded by thrombus formation, occasionally by external compression, or due to a disease involving the vein wall (e.g., vasculitis).

58.1.1 Treatment Options

As a result of the occlusion, whether it involves a branch or the central retinal vein, the retina in the affected area becomes hemorrhagic and edematous. The loss of vision may be the result of the VH, the macular edema, the accompanying ischemia, and/or consequent neovascularization; TRD may also occur. The new vessels can be present both in the retina and the anterior segment; the latter may lead to the development of neovascular glaucoma, which is another potential source of visual loss.

There are numerous treatment modalities ranging from observation1 to grid and/ or panretinal laser, intravitreal injections,2 and implants to radial optic neurotomy, as well as vitrectomy. Table 58.1 provides a few thoughts on the different treatment modalities. The technique described below reflects my typical approach; the other treatment options are not discussed in this book.

58.1.2 The Vitrectomy Option

Vitrectomy is most effective when it is done early, not as one used when all else fails. The advantage of PPV is that, unlike the intravitreal injections, it is usually a one-time intervention; it also avoids the emotional seesaw the patient who

1Convenience or ease should not be the primary criterion when deciding whether intraocular injections or surgery is chosen as the treatment option (see Sect. 8.2).

2Steroid, anti-VEGF.

F. Kuhn, Vitreoretinal Surgery: Strategies and Tactics,

DOI 10.1007/978-3-319-19479-0_58