How must the BRVO diagnosis be confirmed prior to Anti-VEGF?
FFA if haem allows, if not, anti-VEGF anyway
What are the exclusion criteria for BRVO?
- Active infection
- Active neovasc
- V/A <6/60
- Macula oedema of greater than 18month duration
- Stroke/heart attack or TIA in previous 3 months
What BRVO patients are suitable for anti-VEGF treatment?
- With v/a <6/12 with clinically detectable macular oedema
- Retinal thickness >250um (topcon), (300um, spectralis)
If at the 4th appoinment a BRVO patient has better vision that has plateaued and dry OCT what is the treamtent?
Treat and extend to 8 weeks. Extend two weekly thereafter if dry until 12 weeks reached the treat PRN
A BRVO patient on a 12 week interval presents with new fluid what is the treament?
Treat and review again in 8 weeks.
A BRVO patient is seen 16 weeks after the last injection and is still dry what is the management?
Discuss with Med Ret consultant and discharge back to MR clinic
If at the 4th appointment there has been no improvement of va or fluid what is the mangement.
Non-responder to anti-VEGF, either switch to a different anti-VEGF or try Ozurdex
If at 4th appointment vision is still improving but has not plateaued what would be the management?
Inject and see 4 weekly until v/a has plateaued and OCT is dry then extend to 8 weeks.
If fluid occurs between injection intervals what is the clinical management.
Inject and reduce interval by 2 weeks unless at 12 week stage when reduced to 8 week
If a patient is on Lucentis and can not be extended beyond 8 weeks what is the treatment?
Submit therapy application to change to Eylea