Question 9: What other treatment is indicated?

Question 9: What other treatment is indicated?

Answer:

The second aim of treatment is to control the ischemic drive for neovascularization using:

1. Panretinal photocoagulation (PRP) is indicated in diabetic retinopathy but its effectiveness in ischemic CRVO and OIS are debatable. (Hayreh 2007) Treatment with laser may not be possible if there is vitreous haemorrhage or significant cataract.
2. Anti-VEGF agents such as Avastin have shown good effect in recent studies for all aetiologies of NVG. (SooHoo et al 2013)
3. Corticosteroid therapy, either topical or intravitreal therapy has shown incidental benefit for reducing iris neovascularization and decreasing IOP. However in steroid responsive patients this can also increase IOP. (Hayreh 2007)
4. Treatment of the underlying disease such as:
   1. Improving management of diabetes and blood glucose control
   2. Management of microvascular risk factors (blood pressure, cholesterol, blood sugar) to minimise the chance of further vascular events in CRVO and OIS
   3. Carotid ultrasound and cerebrovascular imaging looking for potential occlusions is indicated in OIS