Bevacizumab in the treatment of macular edema in acute central retinal vein occlusions

Even if bevacizumab is unlicensed, a majority of retina specialists still currently recommends it in retinal vein occlusion-related macular edema. For the first time, the results of our studies showed evidence suggesting that an early treatment administered immediately after the onset of venous occlusion, provided a significant and sustained improvement in visual acuity and foveal thickness, with inactive disease (dry retina and stable visual acuity for at least 6 months after the last injection) in most phakic patients with acute central/ hemicentral retinal vein occlusions, making this treatment option a rational and viable therapeutic strategy. Central/ hemicentral retinal vein occlusion has to be considered an ophthalmic emergency. The highlighting of the ocular conditions most
frequently associated with central/ hemicentral retinal vein occlusion (ocular hypertension, primary open angle glaucoma, primary angle closure suspect, primary angle closure, and primary angle closure glaucoma) is mandatory. Regardless of the anti-vascular endothelial growth factor agents used (bevacizumab/ ranibizumab / aflibercept/), and regardless of the treatment approaches chosen (treat-and-extend/ pro re nata algorithm), the efficacy of therapy depends primarily on the precociousness of the therapy after the diagnosis of central/ hemicentral retinal vein occlusion. Any delay in the treatment will adversely influence the restoration of visual functions, which are difficult to correct even with subsequent treatment.