Which treatment combination is used for neovascularization in OIS?

Which treatment combination is used for neovascularization in OIS?

• A. AntiVEGF injections for CME
• B. Panretinal photocoagulation (PRP) and AntiVEGF for NVE/NVI
• C. Pars plana vitrectomy for all cases
• D. Observation without therapy

Answer: (B)

In ocular ischemic syndrome, neovascularization is driven by retinal hypoxia that ramps up VEGF production. The goal is to rapidly control the abnormal vessels and also reduce the underlying ischemic drive for new vessel growth. Panretinal photocoagulation accomplishes the latter by ablating a large extent of nonperfused retina, which lowers VEGF production over time and decreases the stimulus for new vessels. Anti-VEGF injections act quickly to suppress VEGF levels and cause rapid regression of neovascularization on the iris, angle, and retina. Using both together gives immediate control of the neovascular process and a more durable reduction in VEGF driving neovascularization, making it the preferred approach for OIS with NVE/NVI. Relying on anti-VEGF alone can provide fast but temporary relief, since the ischemic drive remains and neovascularization can recur. Purely observational management would let neovascularization progress and increase the risk of neovascular glaucoma. Pars plana vitrectomy is not routinely indicated for all OIS cases and is reserved for specific complications or indications, not as the standard initial treatment for neovascularization in this setting.

In ocular ischemic syndrome, neovascularization is driven by retinal hypoxia that ramps up VEGF production. The goal is to rapidly control the abnormal vessels and also reduce the underlying ischemic drive for new vessel growth. Panretinal photocoagulation accomplishes the latter by ablating a large extent of nonperfused retina, which lowers VEGF production over time and decreases the stimulus for new vessels. Anti-VEGF injections act quickly to suppress VEGF levels and cause rapid regression of neovascularization on the iris, angle, and retina. Using both together gives immediate control of the neovascular process and a more durable reduction in VEGF driving neovascularization, making it the preferred approach for OIS with NVE/NVI.

Relying on anti-VEGF alone can provide fast but temporary relief, since the ischemic drive remains and neovascularization can recur. Purely observational management would let neovascularization progress and increase the risk of neovascular glaucoma. Pars plana vitrectomy is not routinely indicated for all OIS cases and is reserved for specific complications or indications, not as the standard initial treatment for neovascularization in this setting.