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R. McIntosh, Q. Mohamed, S.M. Saw, T.Y. Wong; Interventions for Branch Retinal Vein Occlusion. An Evidence–Based Systematic Review . Invest. Ophthalmol. Vis. Sci. 2006;47(13):922.
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© ARVO (1962-2015); The Authors (2016-present)
Branch retinal vein occlusion (BRVO) is the second most common retinal vascular disease after diabetic retinopathy. Although many new treatments have been advocated, the evidence justifying their use remains unclear. We evaluated the evidence for interventions to treat BRVO.
We conducted a systematic review of all English and non–English language articles on interventions to treat BRVO. Abstracts were retrieved using a keyword search of MEDLINE (1966 – July 2005), EMBASE (1966 onwards), Cochrane Collaborations, NIH Clinical Trials Database, and ARVO (2003–2005). This was supplemented by hand searching the reference lists of selected major review articles. Two investigators independently identified and grouped any randomized clinical studies on interventions in BRVO before collaboration and further analysis. Translation was obtained for all non–English literature.
Out of 4133 citations retrieved, 15 randomized clinical studies comparing intervention with a control group or standard care were identified. An additional 10 randomised uncontrolled clinical studies, 2 comparative, controlled but non–randomized clinical studies and 3 prospective controlled trials where the method of treatment assignment was unclear were also identified and analysed separately. Interventions included macular grid and scatter laser treatment, haemodilution, triamcinolone, pentoxifylline, azetazolamide, troxerutin, ticlodipine, and intravitreal dexamethasone implants. The majority of the randomized trials analysed lacked adequate power, were methodologically poor, or failed to report on long–term visual outcomes. Of particular note, there were no randomized controlled clinical trials on the use of intravitreal triamcinolone for BRVO.
There is limited level 1 evidence for any interventions outside the macular grid and panretinal laser treatment regimen from the Branch Vein Occlusion Study (BVOS) study. There are several ongoing randomized controlled clinical trials on intravitreal triamcinolone, intravitreal dexamethasone impants and chorioretinal anastomosis, but until these results are available, the use of many of new treatments for BRVO are unsupported by current evidence.
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