Visual Loss and Retinal Vein Occlusion: Have We Lost Sight of the Problem?


Peter James Glasman, Louis G Clearkin



Peter James Glasman, St. Paul’s Eye Unit, Royal Liverpool University Hospital, Liverpool, United Kingdom

Louis G Clearkin, Depatment of Opthalmology, Wirral University Teaching Hospital, Wirral, United Kingdom

Correspondence to: Peter James Glasman, St. Paul’s Eye Unit, Royal Liverpool University Hospital, Liverpool, United Kingdom


Telephone: +44-151-7062000

Received: January 27, 2015              Revised: February 10, 2015

Accepted: February 14, 2015

Published online: June 1, 2015



CRVO is a common cause of sight loss. Treatment modalities such as intravitreal anti-VEGF, intravitreal steroids and laser do not address the cause of the pathology, but rather its effects as this letter highlights.


© 2015 ACT. All rights reserved.


Key words: Retinal vein occlusion; Intravitreal steroid; Anti-vegf; Thrombolysis


Glasman PJ, Clearkin LG. Visual Loss and Retinal Vein Occlusion: Have We Lost Sight of the Problem? International Journal of Ophthalmic Research 2015; 1(1): 34-35 Available from: URL:



Thrombosis of the central retinal vein causes central retinal vein occlusion (CRVO)[1]. Current standard treatment modalities, including intravitreal steroid implant, intravitreal anti-vascular endothelial growth factor and laser, are directed at the consequences of the CRVO, rather than the cause itself. Whilst these are useful for treating the effects of vascular leakage and capillary non-perfusion, clearly it would be preferable to reverse the root cause of the pathology if possible.

    Kohner showed in 1976[2] that systemic streptokinase was beneficial in CRVO, with approximately a 3 Snellen line benefit in favour of the treated group. However, this was balanced against a 15% vitreous haemorrhage rate - at the time an untreatable and often blinding complication as it pre-dated modern vitrectomy techniques. The study was also limited by small sample size and wide inclusion criteria, with patients included despite presenting many days after the onset of symptoms. Several authors since have considered “primary” intervention by other methods, including tissue plasminogen activator[3], haemodilution[3], and low molecular weight heparin[4,5]. Whilst these have shown promise, they are limited by a lack of standardisation, and in particular a wide variation in time to treatment, often up to 30 days.

   It is tempting to make an analogy with the recent change in the management of acute stroke. Whereas management had previously been mainly supportive, the focus is now on timely (within 4 hours) thrombolysis, often at regional centres. Whilst funding such a service may be an issue, the current NICE-approved therapies in CRVO, Lucentis and Ozurdex, are costly at £26,200 and £22,831 per QALY respectively. The real-world cost is unknown as both licenses are open-ended, therapy is usually prolonged, and it may be associated with serious complications. We therefore suggest that Kohner’s idea is worth revisiting.



NICE: National Institute for Health and Clinical Excellence, United Kingdom;

QALY: Quality Adjusted Life Year




The author has no conflicts of interest to declare.



1    Browning, David J., and SpringerLink (Online service). Retinal Vein Occlusions: Evidence-based Management. New York, NY: Springer, 2012

2.   Kohner EM, Pettit JE, Hamilton AM, Bulpitt CJ, Dollery CT. Streptokinase in retinal vein occlusion: a controlled clinical trial. BMJ 1976 1, 550-553.

3.   Hattenbach LO, Friedrich AC et al. Retinal vein occlusion and low-dose anti-fibrinolytic therapy: a prospective, randomised controlled multicenter trial of tPA versus hemodilution. Retina 2009; 29 932-940.

4.   Faravash MS et al. Dalteparin in the managment of recent onset central retinal vein occlusion: a comparison with salicylic acid. Can J Ophthal 2008; 43: 79-83.

5.   Ageno W et al. Parnaparin versus aspirin in the treatment of central retinal vein occlusion. A randomised, double blind control study. Thromb Res 2010; 125(2), 137-41.


Peer reviewer: Alparslan SAHIN, Associate Professor, Department of Ophthalmology, Dicle University School of Medicine, 21280, Sur, Diyarbakir, TURKEY.



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