Retinal Venous Occlusive Disease Research Articles

A study on the effect of Anti- VEGF on retinal venous occlusive disease with macular edema in a tertiary health care centre of southern Assam

Macular oedema is considered to be the primary reason for significant visual loss and impaired visual recovery in patients with retinal venous occlusion and rise in VEGF is strongly implicated in macular edema and as such there is a good rationale in treating these conditions with intravitreal anti-vascular endothelial growth factors. Aim of this study was to assess the effect of anti-VEGF (Bevacizumab) on retinal venous occlusive disease with macular edema.This was prospective open label hospital based interventional study done from June 2021 to May 2022 in fifty eyes of fifty patients diagnosed with macular edema secondary to retinal venous occlusion and Snellen’s visual acuity at presentation of less than 6/12 were included in accordance with the inclusion and exclusion criteria.The results shows statistically significant improvement in mean central macular thickness and mean Snellen’s visual acuity at the end of 12 months and factors like Hypertension, Diabetes mellitus, Dyslipidemia and smoking are found to be highly associated with retinal venous occlusive diseases. The intravitreal anti-VEGF (Bevacizumab) has been found to be effective in improving the macular edema and visual acuity in the study population with retinal venous occlusive diseases to a statistically significant level and that it was more pronounced in cases of BRVO, at the completion of the study period.

Management and prognosis of vitreous haemorrhage

AbstractVitreous haemorrhage is one of the most common causes of sudden deterioration in vision with an incidence of seven cases per 100 000 and it is affecting most often only one eye.The most common causes for nontraumatic, spontaneous vitreous haemorrhage include diabetic retinopathy, retinal tear/detachment, vitreoretinal traction resulting from posterior vitreous detachment, retinal venous occlusive disease, ruptured retinal macroaneurysm, and exudative age‐related macular degeneration In the setting of severe vitreous haemorrhage and no visualization of the fundus and without a history of underlying cause the diagnosis may be challenging. B‐scan is the most useful diagnostic tool but ultrasound has limitations both in sensitivity and specificity for excluding retinal tear and detachment, as well as operator dependent variability. General ophthalmologists tend to follow up patients, waiting the haemorrhage to clear or to have some indication for the underlying pathology. This waiting time could compromise the final visual outcome of a vitreous haemorrhage related to retinal breaks or affect the quality of life of patients. With the safety profile of modern small gauge vitreoretinal surgery we would suggest an early referral of all cases to vitreoretinal surgeons as delayed diagnosis and management could implicate consequences affecting the final visual result.

Role of hyperhomocysteinemia and Vitamin B12 deficiency in central and hemi-central retinal vein occlusion: A case-control study.

BACKGROUND:Retinal venous occlusive diseases have been recognized as a major cause of ocular morbidity. Hyperhomocysteinemia could be a potentially modifiable risk factor.OBJECTIVE:To determine the association of hyperhomocysteinemia with central and hemi-central retinal vein occlusion (CRVO and HCRVO), the correlation of serum levels of homocysteine with Vitamin B12 and folate levels and the association of Vitamin B12 deficiency with hyperhomocysteinemia.METHODS:In this case–control study, patients with CRVO and HCRVO, and age- and gender-matched controls without CRVO and HCRVO, who met the eligibility criteria, were enrolled after obtaining informed consent. Data obtained from participants using a questionnaire, complete ophthalmological examination and relevant investigations, including estimation of serum homocysteine, Vitamin B12 and folate levels, were collated and analyzed.RESULTS:Thirty-nine cases with CRVO and HCRVO and 39 age- and gender-matched controls were studied. We found a significant association of hypertension (P < 0.01), hyperlipidemia (P = 0.01), and abnormal blood profile (P < 0.01) with retinal vein occlusion. There was no statistically significant association of hyperhomocysteinemia with CRVO and HCRVO (P = 0.81). However, we found a high prevalence of both hyperhomocysteinemia (43.58% of cases and 53.84% of controls; P = 0.81) and Vitamin B12 deficiency (23.08% of cases and 38.46% of controls; P = 0.14) in cases and controls, without a statistically significant difference between the two groups with respect to both parameters. Our study also found a negative correlation of serum levels of homocysteine with Vitamin B12 (Pearson correlation co-efficient − 0.3874, P = 0.0005), and folate (Pearson correlation coefficient − 0.3886, P = 0.0004) of the study participants. Among the study participants (n = 78), the odds of patients with Vitamin B12 deficiency having hyperhomocysteinemia were 7.0 (2.26–21.72) times those of patients without Vitamin B12 deficiency (P = 0.001). Similarly, among the cases (CRVO, n = 39), the odds of patients with Vitamin B12 deficiency having hyperhomocysteinemia were 7.0 (1.22–40.09) times those of patients without Vitamin B12 deficiency (P = 0.029). In the control group also (non-CRVO, n = 39), the odds of patients with Vitamin B12 deficiency having hyperhomocysteinemia were 6.67 (1.47–30.21) times those of patients without Vitamin B12 deficiency (P = 0.014).CONCLUSION:Hyperhomocysteinemia was not found to be an independent risk factor for retinal vein occlusion in our study. However, we found a high prevalence of hyperhomocysteinemia and Vitamin B12 deficiency in both cases and controls, without a statistically significant difference between the two groups with respect to both parameters. We also found a negative correlation of serum homocysteine levels with Vitamin B12 and folate levels. The odds of patients with Vitamin B12 deficiency having hyperhomocysteinemia were seven times those of patients without Vitamin B12 deficiency. Hypertension, hyperlipidemia, and abnormal blood profile had a significant association with CRVO and HCRVO. Many of the systemic risk factors for retinal vein occlusions are found to be associated with elevation of serum homocysteine levels, which may be part of a final common pathway in bringing about a state of accelerated atherosclerosis, leading to CRVO or HCRVO. Therefore, lowering serum levels of homocysteine by Vitamin B12 and folate supplementation could have a role in the prevention of these diseases.

Methylenetetrahydrofolate reductase polymorphisms as risk factors for retinal venous occlusive disease: A literature review

The role of polymorphisms of methylenetetrahydrofolate reductase (MTHFR) gene in retinal vein occlusion (RVO) is a theme of discussion since the first reports of RVO in patients with MTHFR C677T mutation and without classic acquired risk factors for retinal vascular disease. The association between MTHFR polymorphisms and RVO has been studied over the last 20 years producing conflicting results. This review aims to summarize the literature concerning the role MTHFR polymorphisms as risk factors for RVO.

Longitudinal Assessment of Ellipsoid Zone Mapping Parameters in Retinal Venous Occlusive Disease With Associated Macular Edema.

This work evaluated the longitudinal dynamics of ellipsoid zone (EZ) integrity in retinal vein occlusion (RVO) with macular edema and their relation to outcomes. Clinical characteristics and optical coherence tomography data of patients with RVO and associated macular edema were collected at baseline and at 3 and 12 months. Macular cube scans were exported into EZ and retinal-layer analysis software. Longitudinal EZ parameters and visual acuity (VA) outcomes were regressed and correlated. The study included 108 eyes of 108 patients; all eyes were treated with antivascular endothelial growth factor therapy at the baseline visit. VA improved from 20/97 at baseline to 20/52 at 3 months and 12 months (P<.001), correlating with EZ integrity at each time point (P<.001). At 12 months following initiation of antivascular endothelial growth factor therapy, EZ partial attenuation and EZ total attenuation improved over 12 months from 16.4% to 8.5% (P<.001) and from 12.3% to 5.9% (P<.001), respectively. VA improvement from baseline to 12 months correlated with improvement of EZ partial and total attenuation (P<.001). Baseline EZ characteristics did not predict VA outcomes, but at 3 months, EZ parameters did predict improvement in visual outcomes by 12 months (P<.01). EZ and outer retinal integrity are correlated with functional outcomes in RVO. Following treatment, EZ integrity improves and is associated with functional improvement. In RVO baseline, EZ features were not associated with 1-year VA outcomes, but evaluation of EZ integrity at 3 months was linked to 1-year outcomes.

Risk of Systemic Adverse Events after Intravitreal Bevacizumab, Ranibizumab, and Aflibercept in Routine Clinical Practice

Intravitreal anti-vascular endothelial growth factor (VEGF) pharmacotherapy plays a central role in the management of neovascular age-related macular degeneration (nAMD), diabetic retinal disease (DRD), and retinal venous occlusive disease (RVO). Within clinical trials, rates of systemic serious adverse events (SAEs) after anti-VEGF treatment have been low. However, the comparative systemic safety profile of common anti-VEGF agents remains incompletely understood. The goal of this study was to compare the systemic safety of intravitreal bevacizumab, ranibizumab, and aflibercept in real-world practice. Retrospective cohort study. Using a large U.S. administrative claims database of commercially insured and Medicare Advantage enrollees, we identified adult cohorts receiving initial anti-VEGF injections for nAMD, DRD, and RVO between January 1, 2007, and June 30, 2018. We included patients with 1 year of insurance coverage before initial treatment. We compared predefined systemic outcomes between anti-VEGF agents occurring within 180 days of treatment initiation using propensity score-weighted Cox proportional hazards models. Patients were censored upon treatment with a different anti-VEGF medication or termination of health plan coverage. Primary outcomes were acute myocardial infarction (MI), acute cerebrovascular disease (CVD), major bleeding, and all-cause hospitalization. A total of 87 844 patients received initial anti-VEGF injections for nAMD, DRD, and RVO between January 1, 2007, and June 30, 2018 (69 007 bevacizumab; 10 895 ranibizumab; 7942 aflibercept). Postinjection 180-day event rates per 100 patients for MI, CVD, major bleeding, and all-cause hospitalization were similar for bevacizumab (0.64, 0.59, 0.34, and 10.41, respectively), ranibizumab (0.62, 0.53, 0.40, and 9.44, respectively), and aflibercept (0.63, 0.60, 0.20, and 9.88, respectively). No differences were identified for the risk of MI, CVD, major bleeding, or all-cause hospitalization when comparing the risk-adjusted effect of treatment initiation with bevacizumab versus ranibizumab (hazard ratio [HR], 0.96 [95% confidence interval {CI}, 0.74-1.25]; HR, 1.04 [95% CI, 0.78-1.38]; HR, 0.85 [95% CI, 0.61-1.19]; HR, 1.03 [95% CI, 0.96-1.10], all P > 0.05), bevacizumab versus aflibercept (HR, 0.95 [95% CI, 0.68-1.33], HR, 0.99 [95% CI, 0.71-1.38], HR, 1.02 [95% CI, 0.60-1.74], HR, 1.01 [95% CI, 0.93-1.10], all P > 0.05), or aflibercept versus ranibizumab (HR, 0.91 [95% CI, 0.62-1.35], HR, 1.12 [95% CI, 0.74-1.69], HR, 0.96 [95% CI, 0.53-1.73], HR, 1.02 [95% CI, 0.92-1.13], all P > 0.05). We observed no differences in the risk of acute MI, CVD, major bleeding, or all-cause hospitalization after treatment initiation with intravitreal bevacizumab, ranibizumab, or aflibercept during routine clinical practice.

Noncompliance in Prospective Retina Clinical Trials: Analysis of Factors Predicting Loss to Follow-up

Noncompliance during prospective studies can bias results and limit conclusions. The current study retrospectively investigated the relationship between study subject characteristics and rates of noncompliance in interventional trials involving common causes of blindness. Retrospective analysis of 10 randomized clinical trials. Subjects were enrolled in investigator-initiated trials studying proliferative diabetic retinopathy, neovascular age-related macular degeneration, diabetic macular edema, and retinal venous occlusive disease. Records were reviewed for hypothesized risk factors of noncompliance and rates of noncompliance, which were defined as at least 1 missed visit or exiting the study early. Demographic information, systemic medical history, and ocular medical history, including visual acuity and central retinal thicknesses, were examined retrospectively using Student t test, Pearson χ2 test, and logistic regression. Of 390 subjects included, 212 (54.4%) were compliant with all scheduled study visits and 178 (45.6%) met criteria for noncompliance, with 53 (13.6%) subjects exiting early. Regression models identified 17 variables that were significant in determining subject noncompliance. Among those, distance, comorbidities, diabetic status, concomitant medications, previous clinic visits, length of study, disease under study, and severe adverse events were highly significant risk factors of noncompliance. The current research identified a substantial proportion of subjects who met the criteria for noncompliance within the trials analyzed. The factors identified in the current work are consistent with published clinical observations and the results of previous clinical trials. These results highlight the importance of considering study design and medical history when designing prospective clinical trials in an attempt to minimize data loss.

Retinal Venous Occlusive Diseases and Study of their Risk Factors

Retinal Venous Occlusive Diseases and Study of their Risk Factors

Experimental substantiation of the effectiveness of the “massage” retinal veins for treatment of retinal vein occlusion

Objective: evaluate the effectiveness of treatment of retinal vein occlusion with the use of “massage” of retinal veins on the experimental model of photoinduced retinal venous occlusive disease. Materials and methods. Studies were carried out on 30 rabbits of the Chinchilla breed (30 eyes) weighing 1.5–2.0 kg. In the first stage of the experiment, for all animals the photoinduced thrombosis were modeled by laser irradiation of its retinal veins for 0.3–0.4 seconds at a density of 200 J/cm2 and a wavelength of 662 nm after the administration of “Photoditazine” at a dose of 2.5 mg/kg weight. In the second stage of the experiment, the animals were divided into the main group and the comparison group, depending on the method of treatment: 15 animals of the main group with “massage” of the retinal vein in the form of 5–7 movements with a silicone tip of the scanner Tano, 15 animals of the comparison group with epiretinal administration of recombinant prourokinase in a dose 500 international units (IU). Results. The formation of a parietal thrombus in the simulation of photoinduced the central retinal vein occlusion in the experiment leads to a slowing of perfusion in the affected vessel by (8.0 ± 2.5) s (according to fluorescence angiography), an increase in the thickness of the central parts of the retina by (70.2 ± 9.7) μm (according to optical coherence tomography), to the appearance of crimp and uneven lumen of the retina veins, extensive plasma and hemorrhages (according to the data of ophthalmoscopy). On the model of retinal veins thrombosis, a new method of treating retinal vein occlusion was tested, which showed significant efficacy. It has been established that the use of “massage” of the affected retinal vein reduces the time of venous perfusion by 1.3 times and 1.45 times accelerates the resorption of the edema of the central parts of the retina compared to enzymatic thrombolysis. Conclusions. “Massage” of the retinal veins is an effective method of treating retinal vein occlusion and is not accompanied by damage to chorioretinal structures during manipulation.

Ellipsoid Zone Mapping Parameters in Retinal Venous Occlusive Disease with Associated Macular Edema

To evaluate the association of baseline ellipsoid zone (EZ) parameters on optical coherence tomography (OCT) as calculated by a semi-automated computer algorithm with baseline visual acuity in eyes with retinal vein occlusion (RVO). Retrospective consecutive case series. Patients affected by RVO presenting from January 2011 to December 2014. Baseline demographics, clinical characteristics, and SD-OCT data at presentation were collected. Macular cube scans were exported into a retinal layer analysis software platform and outer retinal parameters were evaluated. Outer retinal/EZ parameters included EZ-retinal pigment epithelium (RPE) volume, central foveal EZ-RPE area, EZ-RPE central subfield thickness (CST), and EZ-RPE central foveal thickness (CFT). In addition, en face EZ mapping features were extracted including percent area with EZ attenuation (i.e., EZ-RPE thickness < 20 μm) and percent area with total EZ loss (i.e., EZ-RPE thickness = 0 μm). Correlation of EZ parameters and baseline visual acuity (VA). Secondary outcome measures: Correlation of EZ parameters with other clinical characteristics and OCT measures of cube volume, cube average thickness, central subfield thickness. One hundred and twelve eyes were included in this analysis. Mean baseline VA was 56.53 ±17.68 ETDRS letters and was inversely associated with total EZ loss and EZ-RPE attenuation (r= - 0.33 and -0.38 respectively, p<0.001). VA was directly associated with all other EZ parameters (r=0.37 to 0.45, p<0.001). The presence of subretinal fluid was strongly linked to central parameters of central foveal EZ-RPE, EZ-RPE-CST, and EZ-RPE-CFT (Kruskal-Wallis test). Conventional OCT parameters (central subfield retinal thickness, cube volume and cube average thickness) did not have significant correlations with EZ measures (-0.3<R<0.3 and/or P>0.05). Baseline EZ integrity is closely linked to presenting visual acuity in eyes with RVO and macular edema. EZ mapping provides an additional metric for evaluating RVO impact on retinal anatomy and potential function.

Multiple thrombophilic risk markers in patients ≺65years of age with retinal vein occlusion

The potential impact of multiple thrombophilic defects on retinal venous occlusive (RVO) diseases with regard to age and various risk factors has not been studied extensively. In aretrospective, multicenter study, thrombophilia data of 128 patients <65years of age with RVO and 110 healthy subjects were evaluated. The main measure outcome was the prevalence of multiple thrombophilic disorders. Multiple thrombophilic defects were significantly more prevalent among RVO patients (18.0%) than among controls (1.8%; P< 0.0001). We identified factor VIII elevation, elevated lipoprotein(a) plasma levels and resistance to activated proteinC as the most prevalent combined disorders. FactorXII deficiency and prothrombin mutation G20210A were found to be isolated thrombophilic risk factors. Multiple thrombophilic defects were significantly associated with RVO recurrence (P= 0.008). Multiple thrombophilic disorders are associated with the development of RVO among patients younger than 65years of age. Moreover, our results suggest that patients with RVO associated with underlying combined thrombophilic defects are at increased risk for RVO recurrence. Further studies are required to analyze whether the diagnosis of combined thrombophilic defects among RVO patients could be apredictor for RVO recurrence.

Evaluating ocular blood flow.

Studies have shown that vascular impairment plays an important role in the etiology and pathogenesis of various ocular diseases including glaucoma, age-related macular degeneration, diabetic retinopathy, and retinal venous occlusive disease. Thus, qualitative and quantitative assessment of ocular blood flow (BF) is a topic of interest for early disease detection, diagnosis, and management. Owing to the rapid improvement in technology, there are several invasive and noninvasive techniques available for evaluating ocular BF, with each of these techniques having their own limitations and advantages. This article reviews these important techniques, with a particular focus on Doppler Fourier domain optical coherence tomography (OCT) and OCT-angiography.

The Evolution of Laser Therapy in Ophthalmology: A Perspective on the Interactions Between Photons, Patients, Physicians, and Physicists: The LXX Edward Jackson Memorial Lecture

To present the evolution of laser therapy in modern ophthalmic practice. Review of published experimental and clinical studies. A review was undertaken of the work of multiple investigators leading to the invention of the laser, its biophysical effects on ocular tissues from which it derives its name (light-amplified stimulation of emitted radiation), and the development of various laser-based devices and methods to treat common ophthalmologic disorders, with particular emphasis on new and emerging retinal and anterior segment applications. Because the eye is optimized for the transmission of light and its transduction into neural signals, lasers are particularly well suited for ophthalmic therapy. This fact and the high demands for precision in therapy have inspired the development of highly sophisticated laser systems that have impacted the treatment of common diseases. These include diabetic retinopathy, age-related macular degeneration, retinal venous occlusive disease, retinopathy of prematurity, and optical aberrations including ametropia, cataract, and glaucoma, among others. Recent developments in scanning laser systems, including image-guided systems with eye tracking, real-time feedback, and ultra-short pulse durations, have enabled increased selectivity, precision, and safety in ocular therapy. However, improved outcomes have been associated with increased cost of medical care, and attention to and optimization of their cost effectiveness will continue to be required in the future. The invention and evolution of modern ophthalmic lasers have enhanced therapeutic options and can serve as a heuristic model for better understanding the process of innovation, including the societal benefits and also unintended consequences, including increased costs.

Ocular diseases in metastatic cutaneous melanoma: review of 108 consecutive patients in two German tertiary centers

To analyze the incidence and spectrum of ocular disease in patients with metastatic cutaneous melanoma. One hundred and eight consecutive patients with metastatic cutaneous melanoma were screened for ocular diseases using standardized eye examination, including measurement of visual acuity and intraocular pressure, slit-lamp examination, funduscopy in mydriasis, and spectral-domain optical coherence tomography (SDOCT) of the retina. Selected cases with atypical findings underwent electrophysiological studies. One patient was examined for hypercortisolism by a dexamethasone suppression test. Ocular diseases were found in 65 out of 108 patients (60 %) with metastatic cutaneous melanoma, significantly more often in older patients (p = 0.004). Cataract was present in 27 patients (25 %), pseudophakia in 22 patients (20 %), macular disease in 29 patients (28 %), diabetic retinopathy in ten patients (9 %), hypertensive retinal disease in 14 patients (13 %), retinal venous and arterial occlusive disease in three patients (3 %), optic neuropathy in four patients (4 %), and uveitis in one patient (1 %). Eight patients (8 %) had choroidal or iridal nevi, one patient (1 %) choroidal hemangioma, and one patient (1 %) choroidal metastasis. No patient had periocular neoplastic lesions. Paraneoplastic retinopathy manifesting as acute exudative polymorphous vitelliform maculopathy (AEPVM)-like disease was diagnosed in two patients (2 %) with multifocal central serous chorioretinopathy and development of vitelliform or fibrin-like subretinal deposits in one patient. Patients with metastatic cutaneous melanoma reveal ocular diseases with a spectrum similar to the normal population of this age range. Very rarely, uveal metastasis as well as paraneoplastic retinopathy can occur.

SEQUENTIAL BILATERAL CENTRAL RETINAL VEIN OCCLUSIONS IN A CYSTIC FIBROSIS PATIENT WITH HYPERHOMOCYSTEINEMIA AND HYPERGAMMA-GLOBULINEMIA

To report a case of sequential bilateral central retinal vein occlusions in a cystic fibrosis patient with hyperhomocysteinemia and hypergamma-globulinemia over 6 years of follow up. Observational case report of one patient. A 31 year-old male with a history of cystic fibrosis presented with a central retinal vein occlusion (CRVO) in his left eye, followed by a CRVO in his right eye 4 years later. His medical workup was significant for elevated levels of homocysteine and gamma-globulins, which coincided with initiation of intravenous immunoglobulin (IVIG) proceeding his second CRVO. We describe a case of sequential bilateral central retinal vein occlusions in a cystic fibrosis patient with hyperhomocysteinemia and hypergamma-globulinemia over 6 years of follow up and discuss the important role of these risk factors in retinal venous occlusive disease.

One day wonder: Fast resolution of macular edema following intravitreal ranibizumab in retinal venous occlusions

Macular edema is a significant cause of vision loss in patients with central retinal vein occlusions and branch retinal vein occlusions. Vascular endothelial growth factor (VEGF) appears to be a key factor in the pathogenesis of this disease. Anti-VEGF therapy, such as intravitreal ranibizumab provides an effective treatment against vision-threatening macular edema. We report three patients of retinal vein occlusion with macular edema who demonstrated overnight resolution of macular edema following treatment with intravitreal ranibizumab (0.5 mg). 3D optical coherence tomography (Optovue) was used as a tool for comparison of the macular thickness before and after treatment. The significant reductions in the central foveal thickness demonstrated in these patients one night after intravitreal injections could have significant influence on modifying current treatment protocols. Early treatment of macular edema related to retinal venous occlusive disease with anti-VEGF injections could result in faster visual rehabilitation in these patients.

FOCAL RETINAL PHLEBITIS

To report three cases of solitary, focal retinal phlebitis. An observational case series. Three eyes in three patients were noted to have unilateral decreased vision, macular edema, and a focal retinal phlebitis, which was not at an arteriovenous crossing. All three patients developed a branch retinal vein occlusion at the site of inflammation. These patients had no other evidence of intraocular inflammation, including vitritis, retinitis, retinal vasculitis, or choroiditis, nor was there any systemic disorder associated with inflammation, infection, or coagulation identified. Focal retinal phlebitis appears to be an uncommon and unique entity that produces macular edema and ultimately branch retinal vein occlusion. In our patients, the focal phlebitis and venous occlusion did not occur at an arteriovenous crossing, which is the typical site for branch retinal venous occlusive disease. This suggests that our cases represent a distinct clinical entity, which starts with a focal abnormality in the wall of a retinal venule, resulting in surrounding exudation and, ultimately, ends with branch retinal vein occlusion.

Hearing loss, uveomeningitis, and stroke in a 55‐year‐old man

Hearing loss, uveomeningitis, and stroke in a 55‐year‐old man

The intravitreal use of corticosteroids

The use of intravitreal steroids was first explored some 35 years ago, and the enthusiasm for its use has waxed and waned over that time. This article reviews the pharmacology of different corticosteroid agents and drug delivery systems. The literature on the utility of steroids is reviewed and categorized by retinal vascular disease entity, that is, diabetic macular edema and retinal venous occlusive disease, age-related macular degeneration, posterior uveitis and pseudophakic macular edema. The significant toxicity and complications that occur with intravitreal and implantable steroids, which significantly limits their usefulness, is reviewed and discussed. It seems likely that the enthusiasm for intraocular steroids as a primary treatment for retinal vascular diseases such as diabetic macular edema and retinal venous occlusive disease will continue to wane further and be supplanted by anti-VEGF therapies. The potent and largely unmatched anti-inflammatory properties of steroids will continue to make this a treatment of choice for posterior uveitis. Implantable or injectable sustained release devices will be particularly useful in these difficult patients where the local toxicity of intraocular steroids compares favorably against the more significant systemic toxicity of systemic immunosuppressive and immunomodulatory agents.

SCOREing in Retinal Venous Occlusive Disease

SCOREing in Retinal Venous Occlusive Disease