![]() 29, 30 This article describes findings from the SCORE-CRVO trial. The Standard Care vs Corticosteroid for Retinal Vein Occlusion (SCORE) Study, sponsored by the National Eye Institute, is a clinical trial designed to compare 1-mg and 4-mg doses of intravitreal triamcinolone with standard care for treatment of vision loss associated with macular edema secondary to perfused CRVO and branch retinal vein occlusion (BRVO). Other formulations such as compounded preservative-free triamcinolone acetonide are also used in the clinical setting. Intravitreal triamcinolone is used by ophthalmologists in the clinical setting as a readily available pharmacologic agent (Kenalog 40 Bristol-Myers Squibb, Princeton, New Jersey, or Triesence Alcon Inc, Fort Worth, Texas), though use for the treatment of macular edema is off label. 27 Additionally, corticosteroids may also have a neuroprotective effect that may be beneficial in eyes with CRVO. 25, 26 Inflammation may also contribute to the pathology of CRVO, and the anti-inflammatory properties of corticosteroids may play a role in the attenuation of the disease process. 23, 24 Corticosteroids have been demonstrated to inhibit the expression of VEGF and therefore may be an effective therapy for macular edema. 20 - 22 Therefore, attenuation of the effects of VEGF, noted to be upregulated in eyes with CRVO, may reduce macular edema associated with CRVO. The rationale for the use of corticosteroids to treat macular edema secondary to CRVO follows the observation that the increase in retinal capillary permeability that results in macular edema may be caused by a breakdown of the blood retina barrier mediated in part by VEGF, a 45-kDa glycoprotein. Despite the shortcomings of these case series, intravitreal triamcinolone is currently in use for treatment of CRVO. ![]() 16 - 19 Most of these case series lacked long-term follow-up and adequate numbers of study participants. Beginning in 2002, a few case series suggested intravitreal triamcinolone as a potentially efficacious therapy for vision loss and retinal thickening in patients with CRVO, but suggested that some patients develop steroid-related complications such as elevated intraocular pressure (IOP) and cataract injection-related complications such as retinal detachment and endophthalmitis were also reported. 8 - 15 Treatment of macular edema secondary to CRVO with intravitreal injection(s) of triamcinolone acetonide (hereafter referred to as intravitreal triamcinolone) has been evaluated recently. Such treatments include vitrectomy surgery, radial optic neurotomy, intravitreal injection of tissue plasminogen activator, and intravitreal injection of aptamers or antibodies targeted at vascular endothelial growth factor (VEGF). Therefore, at present there is no proven, effective therapy for vision loss associated with macular edema secondary to CRVO.ĭuring the last decade, a number of additional treatments for macular edema secondary to CRVO have been investigated. 7 Although there was a definite decrease in macular edema on fluorescein angiography in the treatment group when compared with the observation group, this did not translate to a direct visual improvement. 5 - 7 The natural history of macular edema secondary to CRVO was delineated in the Central Vein Occlusion Study (CVOS), which found no significant difference in visual outcome between the treatment (grid photocoagulation) and observation groups at any follow-up point. Macular edema is a frequent cause of vision loss in eyes with CRVO. ![]() 3 In the Beaver Dam cohort, central and branch retinal vein occlusion accounted for 12% of eyes that developed severe vision loss over a 15-year period. 2 The 15-year cumulative incidence of CRVO was 0.5% in the Beaver Dam Eye Study. 1 - 4 The prevalence of CRVO was estimated to be 0.4% in the Blue Mountains Eye Study. Central retinal vein Occlusion (CRVO) is an important cause of vision loss worldwide. ![]()
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