Central retinal vein occlusion
ICD-10 H34.8 · ICD-11 9B74.1

Treatment of Central Retinal Vein Occlusion with Iris or Retinal Neovascularization

Clinical Scenario

This protocol addresses central retinal vein occlusion (CRVO) complicated by the development of retinal neovascularization and/or iris neovascularization — a high-risk presentation that requires prompt intervention to control pathological angiogenesis.

In patients who develop iris neovascularization (rubeosis iridis) or retinal neovascularization following a CRVO, treatment aims to achieve sustained reduction in the severity of anterior segment neovascularization.

Treatment Approach

The primary long-term intervention for CRVO with neovascularization centres on a surgical laser procedure targeting the peripheral retina. An intravitreal agent directed at the angiogenic pathway may also play a role — either at the outset or in an adjunctive capacity when the laser treatment alone is insufficient.

The structured regimen — including the specific procedure, sequencing, and criteria for adjunctive therapy — is available in the full protocol.

Complete algorithm, treatment targets, and evidence summary available below.

Instant Access to Structured Evidence-Based Regimens

References

DOI: 10.1016/j.ophtha.2024.12.025
  1. In patients with CRVO with retinal and/or iris neovascularization, dense peripheral PRP is indicated.
  2. For individuals who develop iris neovascularization or retinal neovascularization following a CRVO, the best long-term treatment is often dense peripheral panretinal photocoagulation surgery (PRP).
  3. Additionally, anti-VEGF agents that may or may not treat other targets can be used in an adjunctive manner when complete PRP is insufficient to control angiogenesis.
  4. Often, initial treatment with an anti-VEGF agent is helpful for an immediate but not a sustained benefit, and it may also improve the ability to deliver a complete laser surgery treatment.
  5. Anti-vascular endothelial growth factor agents are commonly used to treat the macular edema, reduce the severity of anterior segment neovascularization, and lower the risk of ocular angiogenesis.
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