Risk Factors And Management Of Retinal Venous occlusive Disease

SUMMERY AND CONCLUSIONVenous obstructive disease of the retina is a frequent cause of retinal vascular visual loss. It usually affect patients who are 50 years of age or older. Many diseases whether systemic or local were claimed to be predisposing factors of the disease. The complications of the obstruction vary from mild to sever visual impairment.In this study, a review of the aspects concerning the risk factors and management of retinal vein occlusion is recited .Fifty patients (51 eyes) were included where one patient had bilateral RVO), 23 eyes were treated by laser photocoagulation and 28 eyes were followed as control with medical treatment. The patients were randomly assigned to laser photocoagulation group or medical group. The argon laser was used to perform grid pattern photocoagulation toward the macular oedema and scatter peripheral pattern to nonperfused retina before developing neovscularization. The laser parameter varied according to each case to produce the desired effect .The patients were re-evaluated followed up for 12 months , the analysis of results were done and compared to other published studiesThe pathogenesis of retinal vein occlusion remains obscure . Some systemic diseases were frequently associated with retinal vein occlusion e.g systemic arterial hypertension (66%), hyperlipidemia (20 %) and diabetes mellitus (20 % ) . Other diseases e.g glaucoma (18%), vascular accidents (10%), blood dyscrasias, and dysproteinemia were also implicated.Management considerations for patients with CRVO include treatment of associated medical conditions. Grid pattern photocoagulation for macular oedema yielded no benefit in improving visual acuity where mean gain VA in medical group was 0.018 and in laser group was 0.005. Of note, there was a trend suggesting that it might be beneficial in improving visual acuity in younger patients. Panretinal photocoagulation was beneficial in preventing neovscularization when used before any neovascularization has occurred, it made a statistical significance in this study ( p* = 0.04) .Photocoagulation of macular oedema of BRVO cases of at least 3 months duration is recommended, where the mean gain of visual acuity in the laser group was significantly higher than that of the medical group ( p*= 0.048 ). Scatter photocoagulation reduced the risk of developing neovascularization in eyes with nonperfusion of at least 5 disc diameters , where no new vessels were developed in this study with p* =0.03.In conclusion, some systemic diseases are frequently associated with retinal vein occlusion e.g systemic arterial hypertension, hyperlipidemia, diabetes mellitus and glaucoma . Argon laser photocoagulation for macular oedema after BRVO is beneficial treatment in improving visual acuity while there is no difference invisual acuity between treated and non treated group after CRVO. Prophylactic scatter photocoagulation whether panretinal in CRVO or sectorial in BRVO to nonperfused retina is beneficial in preventing neovscularization where it made a statistical significance between treated and non treated group in this study .