Elsevier

Ophthalmology

Volume 114, Issue 5, May 2007, Pages 835-846, 854
Ophthalmology

Original Article
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.
https://doi.org/10.1016/j.ophtha.2007.01.010Get rights and content

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.

Section snippets

Sources and Methods of Literature Search

The authors conducted a comprehensive search to identify all relevant randomized clinical trials (RCTs) evaluating interventions for BRVO. Studies lacking a control group that used either a placebo or current best practice as the control method and studies with fewer than 3 months follow-up were excluded because outcomes from these studies may represent simply the natural history of the disease or fail to evaluate clinically significant longer-term outcome. English and non-English language

Laser Treatment

There were 5 RCTs that evaluated the use of laser photocoagulation to treat macular edema and neovascularization secondary to BRVO. Three RCTs investigated the efficacy of grid macular laser treatment for macular edema secondary to BRVO.1, 17, 18

The Branch Vein Occlusion Study (BVOS) Group1 evaluated whether grid macular laser photocoagulation improved VA in patients with VA of 20/40 or worse resulting from macular edema secondary to BRVO. This multicenter RCT assigned 139 patients to either

Clinical Recommendations

As this review shows, many of the studies examining interventions for BRVO had methodological limitations, including insufficient power resulting from small sample sizes, short follow-up periods, absence of a control group or an appropriate control group (absence of placebo or best practice intervention as the control group), and lack of distinction between clinical entities.

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    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).

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