Comment on: ‘Central retinal vein occlusion: modifying current treatment protocols’

Romanian ophthalmologists in the renowned ophthalmic journals worldwide

The authors are discussing over 80 articles that they have published in the last 5 years in the renowned ophthalmic journals worldwide, which have approached, for the first time in the ophthalmic literature, the following 4 topics: the acute central/ hemicentral retinal vein occlusion, the therapeutic interventions in the fellow eye of patients with unilateral malignant glaucoma, the persistent diabetic macular edema, and the current researches in patients with neovascular age-related macular degeneration.

Bevacizumab in the treatment of acute central/hemicentral retinal vein occlusions

Even if bevacizumab is unlicensed, a majority of retina specialists still currently recommends it in retinal vein occlusion-related macular edema. For the first time, the results of our studies showed evidence suggesting that an early treatment administered immediately after the onset of venous occlusion, provided a significant and sustained improvement in visual acuity and foveal thickness, with inactive disease (dry retina and stable visual acuity for at least 6 months after the last injection) in most phakic patients with acute central/ hemicentral retinal vein occlusions, making this treatment option a rational and viable therapeutic strategy. Central/ hemicentral retinal vein occlusion has to be considered an ophthalmic emergency. The highlighting of the ocular conditions most frequently associated with central/ hemicentral retinal vein occlusion (ocular hypertension, primary open angle glaucoma, primary angle closure suspect, primary angle closure, and primary angle closure glaucoma) is mandatory. Regardless of the anti-vascular endothelial growth factor agents used (bevacizumab/ ranibizumab / aflibercept/), and regardless of the treatment approaches chosen (treat-and-extend/ pro re nata algorithm), the efficacy of therapy depends primarily on the precociousness of the therapy after the diagnosis of central/ hemicentral retinal vein occlusion. Any delay in the treatment will adversely influence the restoration of visual functions, which are difficult to correct even with subsequent treatment.