Interventions for branch retinal vein occlusion: an evidence-based systematic review.
OBJECTIVE
To assess the evidence on interventions to improve visual acuity (VA) and to treat macular edema and/or neovascularization secondary to branch retinal vein occlusion (BRVO).


CONCLUSIONS
Branch retinal vein occlusion is the second most common retinal vascular disease.


METHODS
English and non-English articles were retrieved using a keyword search of Medline (1966 onwards), Embase, the Cochrane Collaboration, the National Institute of Health Clinical Trials Database, and the Association for Research in Vision and Ophthalmology Annual Meeting Abstract Database (2003-2005). This was supplemented by hand searching references of review articles. Two investigators independently identified all randomized clinical trials (RCTs) with more than 3 months' follow-up.


RESULTS
From 4332 citations retrieved, 12 RCTs were identified. There were 5 RCTs on laser photocoagulation. Grid macular laser photocoagulation was effective in improving VA in 1 large multicenter RCT, the Branch Vein Occlusion Study (BVOS), but 2 smaller RCTs found no significant difference. The BVOS showed that scatter retinal laser photocoagulation was effective in preventing neovascularization and vitreous hemorrhage in patients with neovascularization, but a subsequent RCT found no significant effect. Randomized clinical trials evaluating intravitreal steroids (n = 2), hemodilution (n = 3), ticlopidine (n = 1), and troxerutin (n = 1) showed limited or no benefit.


CONCLUSIONS
There is limited level I evidence for any interventions for BRVO. The BVOS showed that macular grid laser photocoagulation is an effective treatment for macular edema and improves vision in eyes with VA of 20/40 to 20/200, and that scatter laser photocoagulation can effectively treat neovascularization. The effectiveness of many new treatments is unsupported by current evidence.
McIntosh
Rachel L
RL
Centre for Eye Research Australia, University of Melbourne, Melbourne, VIC, Australia.
Mohamed
Quresh
Q
Saw
Seang Mei
SM
Wong
Tien Yin
TY
D020533:Angiogenesis Inhibitors / Q000627:therapeutic use; D019317:Evidence-Based Medicine; D005938:Glucocorticoids / Q000627:therapeutic use; D006438:Hemodilution / Q000379:methods; D006801:Humans; D017075:Laser Coagulation / Q000379:methods; D008269:Macular Edema / Q000517:prevention & control; D013508:Ophthalmologic Surgical Procedures; D016032:Randomized Controlled Trials as Topic; D015861:Retinal Neovascularization / Q000517:prevention & control; D012170:Retinal Vein Occlusion / Q000628:therapy*; D014792:Visual Acuity; D014821:Vitrectomy; D014823:Vitreous Hemorrhage / Q000517:prevention & control
D020533:Angiogenesis Inhibitors; D005938:Glucocorticoids