Monitoring
Patients with ischemic central retinal vein occlusion (CRVO) or ischemic branch retinal vein occlusion (BRVO) should be monitored monthly for the first 6 months for the development of neovascularization, pupillary assessment for a relative afferent pupillary defect, measurement of intraocular pressure, stereoscopic exam of posterior pole after dilation, optical coherence tomography imaging when appropriate, and peripheral retina and vitreous exam when indicated.[4][24] They should then be re-examined every 3 months for 6 months, and then every 6 months. Gonioscopy should be performed when intraocular pressure is elevated to rule out neovascularization of the angle.
In patients with CRVO, delaying treatment with vascular endothelial growth factor (VEGF) inhibitors for up to 6 months has been shown to lead to reduced visual improvements compared to the immediate initiation of treatment. Therefore, treatment with VEGF-inhibitors should usually be started as soon as the diagnosis of CRVO is made and only deferred if a joint decision is made for a particular individual.[3]
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