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Q.A. Mohamed, R.L. McIntosh, S.M. Saw, T.Y. Wong; Interventions for Central Retinal Vein Occlusionan Evidence–Based Systematic Review . Invest. Ophthalmol. Vis. Sci. 2006;47(13):923.
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© ARVO (1962-2015); The Authors (2016-present)
Central retinal vein occlusion (CRVO) is a common cause of visual morbidity and many different interventions have been advocated, but the evidence justifying their use remains unclear. We evaluated the evidence for interventions to treat CRVO.
We conducted a systemic review of CRVO interventions. English and non–English language articles 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.
Out of 4133 citations retrieved, 18 randomized clinical studies comparing intervention with a control group or standard care were identified. Additionally, 5 randomized 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 analyzed separately. Interventions included in randomized, controlled clinical trials include macular grid and panretinal laser treatment, haemodilution, streptokinase, prostacyclin, pentoxifylline, azetazolamide, troxerutin, ticlodipine, and intravitreal dexamethasone implants. There were no randomized controlled clinical trials on intravitreal triamcinolone. Many of the studies analyzed were methodologically poor, lacked adequate power, or failed to report on long–term visual outcomes.
There is limited level 1 evidence for any interventions outside the macular grid and panretinal laser treatment from the Central Vein Occlusion Study (CVOS). The results of ongoing randomized controlled clinical trials on intravitreal triamcinolone, intravitreal dexamethasone impants and chorioretinal anastomosis identified from the NIH Clinical Trials Database are awaited with interest. More robust randomized, double–masked, placebo controlled clinical trials are needed to support the use of many of newly advocated treatments for CRVO.
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