OCT-A Choroidal and Retinal Findings in Patients with Retinal Vein Obstruction

This chapter provides an overview of various retinal abnormalities, pathophysiologies, structural and vascular findings, and therapeutic modalities used to address retinal vein obstruction (RVO) and its associated consequences, which includes vision loss due to macular edema, retinal bleeding, and neovascular glaucoma (NVG). RVO encompasses central retinal vein occlusion (CRVO) and branch retinal vein occlusion (BRVO). Recent research has highlighted the significance of optical coherence tomographic angiography (OCT-A) imaging in managing retinal complications stemming from venous occlusion. Among the primary causes of vision impairment due to RVO complications are perfused and nonperfused macular edema, with the latter being the most prevalent. OCT-A imaging has been instrumental in identifying alterations in vascular blood perfusion and vessel density. Treatment options for macular edema resulting from RVO include laser photocoagulation therapy, which has shown inconsistent results. Additionally, macular edema can be addressed with an implant that releases corticosteroids directly into the eye. Current treatments for RVO involve antivascular endothelial growth factor (anti-VEGF) drugs, such as ranibizumab and aflibercept, as well as the recently approved dual-acting faricimab. Furthermore, the port delivery system with ranibizumab (PDS) can enhance outcomes and compliance in RVO management. RVO treatment plays a critical role in preventing sight-threatening complications.