We read with great interest the article by Chatziralli et al1 entitled “Ranibizumab for retinal vein occlusion. Predictive factors and long-term outcomes in real-life data” published in Retina Journal 2017; doi: 10.1097/IAE.0000000000001597. February 28, 2017. The study evaluated the long-term anatomical and functional outcomes in patients with retinal vein occlusion (RVO), either central RVO (CRVO) or branch RVO, treated with intravitreal ranibizumab (Lucentis; Genentech, Inc, South San Francisco, CA) and determined the predictive factors of the final visual outcome. Negative predictive factors were found to be increasing age, increasing macular thickness, the presence of intraretinal fluid, the duration of RVO of >3 months, the ischemic type of RVO, the cystoid type of edema, and the external limiting membrane and ellipsoid zone disruption. The authors concluded that ranibizumab seems to be safe and effective in the treatment of RVOs. We would like to address several challenges that have arisen from the study regarding the CRVO population, which can be specifically summarized below.
Altogether, the central/hemicentral RVO has to be considered an ophthalmic emergency. Therefore, therapy with anti–vascular endothelial growth factor agents has to be promptly applied as soon as possible after CRVO onset. The sooner the treatment is started after CRVO onset, the sooner the patient is likely to have gains in BCVA and foveal thickness. Any delay in the initiating therapy will adversely affect the restoration of visual functions, which are difficult to recover even with subsequent treatment. Regardless of the antiangiogenic agent chosen (e.g., bevacizumab/ranibizumab), the treatment paradigms used (e.g., treat-and-extend, pro re nata, fixed-interval, or escalated algorithm), the patient age, and the type of occlusion (ischemic/nonischemic form), the efficacy of treatment depends primarily on the promptness of the therapy after CRVO onset.