For a patient with high-risk characteristics on fluorescein angiography (FFA) following a branch retinal vein occlusion (BRVO), the Branched Retinal Vein Occlusion Study (BVOS) recommended laser treatment when:
- A Neovascularisation was present at the disc (NVD) regardless of extent
- B Nonperfusion area exceeds 5 disc areas on FFA, with prophylactic scatter laser to prevent neovascularisation
- C Visual acuity dropped below 6/18 due to macular oedema at initial presentation
- D Neovascularisation of disc or retina was identified, using sector photocoagulation ✓
Explanation
The BVOS demonstrated that sector scatter photocoagulation significantly reduced the risk of vitreous haemorrhage (from neovascularisation) when applied to eyes that had already developed neovascularisation from BRVO. Prophylactic treatment of nonperfused areas before neovascularisation developed (even >5 disc areas) was NOT recommended by BVOS as it did not improve outcomes in that subgroup. For macular oedema from BRVO, the BVOS also showed grid laser improved visual acuity when VA was 6/18 or worse and oedema persisted beyond 3–6 months. Anti-VEGF injections (bevacizumab, ranibizumab) are now first-line for BRVO-related macular oedema (BRAVO trial).
Reference: Khurana Comprehensive Ophthalmology, 7th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.