BRVO

Question 1

How must the BRVO diagnosis be confirmed prior to Anti-VEGF?

Answer 1

FFA if haem allows, if not, anti-VEGF anyway

Question 2

What are the exclusion criteria for BRVO?

Answer 2

• Active infection
• Active neovasc
• V/A <6/60
• Macula oedema of greater than 18month duration
• Stroke/heart attack or TIA in previous 3 months

Question 3

What BRVO patients are suitable for anti-VEGF treatment?

Answer 3

• With v/a <6/12 with clinically detectable macular oedema
• Retinal thickness >250um (topcon), (300um, spectralis)

Question 4

If at the 4th appoinment a BRVO patient has better vision that has plateaued and dry OCT what is the treamtent?

Answer 4

Treat and extend to 8 weeks. Extend two weekly thereafter if dry until 12 weeks reached the treat PRN

Question 5

A BRVO patient on a 12 week interval presents with new fluid what is the treament?

Answer 5

Treat and review again in 8 weeks.

Question 6

A BRVO patient is seen 16 weeks after the last injection and is still dry what is the management?

Answer 6

Discuss with Med Ret consultant and discharge back to MR clinic

Question 7

If at the 4th appointment there has been no improvement of va or fluid what is the mangement.

Answer 7

Non-responder to anti-VEGF, either switch to a different anti-VEGF or try Ozurdex

Question 8

If at 4th appointment vision is still improving but has not plateaued what would be the management?

Answer 8

Inject and see 4 weekly until v/a has plateaued and OCT is dry then extend to 8 weeks.

Question 9

If fluid occurs between injection intervals what is the clinical management.

Answer 9

Inject and reduce interval by 2 weeks unless at 12 week stage when reduced to 8 week

Question 10

If a patient is on Lucentis and can not be extended beyond 8 weeks what is the treatment?

Answer 10

Submit therapy application to change to Eylea