A 60-year-old hypertensive man presents with sudden painless loss of vision in the left eye. Fundus examination reveals diffuse flame-shaped haemorrhages in all four quadrants, disc oedema, dilated tortuous veins, and cotton-wool spots. OCT shows macular oedema. What is the primary treatment goal for the macular oedema in this condition?
- A Panretinal photocoagulation (PRP)
- B Intravitreal anti-VEGF injection ✓
- C Oral acetazolamide
- D Intravitreal triamcinolone only without anti-VEGF
Correct answer: B. Intravitreal anti-VEGF injection
Explanation
Central retinal vein occlusion (CRVO) with macular oedema is the diagnosis. Current evidence from CRUISE, HORIZON, and GALILEO trials establishes intravitreal anti-VEGF agents (ranibizumab, aflibercept) as first-line therapy for CRVO-related macular oedema, as they reduce oedema and improve visual acuity. PRP is indicated for preventing neovascular complications (rubeosis iridis, neovascular glaucoma) in ischaemic CRVO, not for macular oedema per se. Oral acetazolamide has no established role. Intravitreal steroids are a second-line option when anti-VEGF is contraindicated.
Reference: Khurana Comprehensive Ophthalmology, 7th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.