What are the complications of retinal vein occlusion?
Someone with retinal vein occlusion needs close follow-up so that any complications can be picked up early and treated where possible.
- Macular oedema. This is swelling of the macula at the centre of the retina. It is the main reason why someone with retinal vein occlusion may develop permanent visual problems.
- Neovascularisation. This is abnormal new blood vessel formation at the back of the eye. About one third of people with retinal vein occlusion develop this problem. If abnormal new blood vessels form, this can sometimes lead to increased pressure within the eye and to glaucoma. Also, the new blood vessels are of a poor quality and can sometimes bleed. Another complication is that the new blood vessels can increase the risk that the retina becomes detached. See separate leaflet called Retinal Detachment for more details.
About 1 in 5 patients with retinal vein occlusions develop extra, abnormal blood vessels in the eye. This is neovascularisation. The new blood vessels are stimulated to grow by the shortage of oxygen following the vein blockage. However, they are abnormal in the sense that they are abnormally leaky, and tend to leak fluid and proteins into the eye.
These abnormal blood vessels tend to grow on the iris (the coloured part of the eye), or on the retina itself. They can leak and bleed, and they can also cause a pressure rise in the eye, leading to glaucoma or to further loss of vision. This can normally be prevented by laser treatment to the retina, which is most effective if applied before vision is lost. For this reason, patients with central retinal vein occlusions are normally checked every four to six weeks for six months but branch retinal vein occlusions can be checked less often as the risk is much less.
How are the complications treated?
- Laser treatment can be used to help treat both macular oedema (swelling of the retina in the macular area, which reduces the oxygen supply) and abnormal blood vessel development. A different kind of laser can be used where the vein occlusion causes neovascularisation leading to glaucoma.
- Surgical options aimed at relieving pressure and improving flow through the retinal veins have been studied for the treatment of retinal vein occlusion, but they have not been found to be effective; also, the complication rates are high.
- Arteriovenous sheathotomy is a surgical treatment which aims to improve flow in the affected vein by detecting the artery which is 'squashing' it and separating them. It is performed at the time as a vitrectomy (removal of the vitreous humour from the eye). It is currently being researched and evaluated.
Further reading and references
Retinal Vein Occlusion (RVO) Guidelines; Royal College of Ophthalmologists (July 2015)
Aflibercept for treating visual impairment caused by macular oedema after branch retinal vein occlusion; NICE Technology Appraisal Guidance, September 2016
Dexamethasone intravitreal implant for the treatment of macular oedema caused by retinal vein occlusion; NICE Technology Appraisal Guidance, July 2011
Anti-VEGF for Retinal Vein Occlusion: Patient Information; Moorfields Eye Hospital
Patel A, Nguyen C, Lu S; Central Retinal Vein Occlusion: A Review of Current Evidence-based Treatment Options. Middle East Afr J Ophthalmol. 2016 Jan-Mar23(1):44-8. doi: 10.4103/0974-9233.173132.
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