Retinal vein occlusion therapy reference (2026)

Retinal vein occlusion therapy in 2026 organises around several components.

Acute and ongoing macular edema treatment: anti-VEGF intravitreal therapy is first-line. Options include ranibizumab, aflibercept (including high-dose 8 mg formulation that extends dosing intervals), faricimab (which adds Ang-2 inhibition to VEGF-A blockade), and brolucizumab. Treatment is typically loading doses followed by extension based on response.

Intravitreal corticosteroid: dexamethasone implant, fluocinolone implant in selected cases. Useful in patients with limited anti-VEGF response or for whom frequent injection is impractical.

Laser photocoagulation: focal laser for branch retinal vein occlusion (BRVO) macular edema in selected cases (less commonly used in the anti-VEGF era). Sectoral laser for retinal neovascularisation when present.

Systemic care integration: RVO is associated with elevated risk for cardiovascular events. Structured systemic workup includes blood pressure assessment, lipid evaluation, blood glucose, atrial fibrillation evaluation in appropriate patients, and primary care or cardiology referral as indicated. Patients with RVO benefit from comprehensive cardiovascular risk management.

Follow-up imaging: optical coherence tomography (OCT) is the standard for monitoring macular edema. Wide-field imaging assesses for retinal ischemia and neovascularisation.

Emerging mechanism tier: programs targeting alternative pathways (Tie2, complement, neuroprotection) are in late-stage trials. Sustained-release delivery formulations are in development.

The care-pathway question matters. RVO management benefits from structured retinology care plus primary-care or cardiology integration for systemic workup. Many patients with RVO are inadequately worked up systemically; structured care pathways improve this.