This Issue At A Glance

A study by Campochiaro et al (p. 795) assessing the relationship of blocking vascular endothelial growth factor (VEGF) on progression of retinal nonperfusion (RNP) in patients with macular edema due to central retinal vein occlusion (CRVO) or branch retinal vein occlusion (BRVO) yielded a new insight: high levels of VEGF contribute to the progression of RNP, as evidenced by a reduction in progression by ranibizumab (RBZ) injections. Investigators studied data from 2 randomized phase III RBZ trials. At the month 6 primary endpoint, the percentage of patients with CRVO and no RNP was significantly greater in the RBZ groups versus the sham group, results mirrored in the BRVO patients. The authors conclude that vascular occlusion constitutes the inciting event that has acute consequences such as retinal ischemia and increased levels of VEGF. The high VEGF then becomes a key contributor to the disease by worsening retinal ischemia and promoting RNP. Timely treatment to block VEGF prevents RNP from worsening, promotes perfusion, and eliminates a perpetuating feedback loop.