A Critical Modern Review on BRVO (Branch Retinal Vein Occlusion)
Journal name: Ayushdhara
Original article title: A Critical Modern Review on BRVO (Branch Retinal Vein Occlusion)
AYUSHDHARA is an international peer-reviewed journal. It focuses on research in Ayurveda, Yoga, Unani, Siddha, Homeopathy, Allopathy, and Pharmaceutical Sciences.
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Original source:
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Narender Chanchal
Assistant Professor, Department of Shalakya Tantra, Kunwar Shekhar Vijendra Ayurveda Medical College & Research Centre, Shobhit University, Gangoh, Saharanpur, Uttar Pradesh,
Smriti Kaul
MS Scholar, PG Department of Shalakya Tantra, Patanjali Bhartiya Ayurvigyan Evum Anusandhan Sansthan, Haridwar, Uttarakhand, India
Daya Shankar Singh
Associate Professor, PG Department of Shalakya Tantra, Patanjali Bhartiya Ayurvigyan Evum Anusandhan Sansthan, Haridwar, Uttarakhand, India
Munna Kumar
Assistant Professor in Shalakya Tantra Department, Govt A S Ayurved College and Hospital Begusarai, Bihar, India.
Ayushdhara:
(A peer-reviewed, bi-monthly open-access journal)
Full text available for: A Critical Modern Review on BRVO (Branch Retinal Vein Occlusion)
Year: 2021 | Doi: 10.47070/ayushdhara.v8i6.854
Copyright (license): CC BY-NC-SA 4.0
Download the PDF file of the original publication
Summary of article contents:
Introduction
Branch Retinal Vein Occlusion (BRVO) is a prevalent cause of retinal vascular disease, often leading to significant vision impairment. Epidemiological studies indicate that the condition affects an estimated 13.9 million adults worldwide, with a higher prevalence seen among individuals aged sixty to seventy. Risk factors for BRVO include systemic hypertension, diabetes, smoking, hyperlipidemia, and age-related arterial changes, with the condition presenting as sudden, painless loss of vision or visual field defects. Various treatments are available, and ongoing research aims to explore new therapeutic options for managing BRVO and its associated complications.
Pathogenesis and Risk Factors
The pathogenesis of BRVO generally involves the interruption of blood vessel flow at retinal venous crossings, with arterial compression playing a significant role. Studies show that this obstruction often leads to the elevation of vascular pressure upstream, subsequently causing intraretinal hemorrhages, macular edema, and ischemia. Factors such as hypertension, arteriolar narrowing, and other cardiovascular risk factors contribute to BRVO's occurrence, while younger patients may exhibit unique risk factors, including thrombophilic disorders. Understanding these associations helps identify patients at higher risk and guides potential preventive measures.
Treatment Modalities
BRVO treatment has evolved significantly, with intravitreal anti-VEGF therapy becoming a primary management strategy due to its promising outcomes in improving visual acuity and reducing macular edema. Agents like ranibizumab, aflibercept, and bevacizumab have been studied for their efficacy, showing that intravitreal injections yield better results compared to traditional laser therapy. While options like vitrectomy and steroid injections are available, they are typically considered in specific cases or as second-line treatments. The ongoing investigation into combination therapies suggests potential benefits in maximizing therapeutic effects while minimizing treatment burdens.
Conclusion
BRVO represents a common yet potentially crippling vision disorder, and a variety of effective treatments are now available. Ongoing studies and clinical trials will be crucial in establishing optimal treatment protocols and identifying suitable patient populations for specific therapeutic strategies. With advancements in anti-VEGF therapies and emerging research on combination treatments, there's potential for improved management of BRVO, underscoring the need for continued exploration in this area to optimize patient outcomes and reduce the risk of vision loss stemming from this condition.
FAQ section (important questions/answers):
What is Branch Retinal Vein Occlusion (BRVO)?
BRVO is a common retinal vascular disease that occurs when a branch of the retinal vein becomes obstructed, leading to vision loss. It is often associated with risk factors like age, hypertension, and diabetes.
What are the common symptoms of BRVO?
Patients with BRVO typically experience sudden, painless vision loss or visual field defects. Some may also notice floaters if there's vitreous hemorrhage associated with the occlusion.
What treatment options are available for BRVO?
Treatment options include anti-VEGF therapy, laser treatments, and vitrectomy. New therapies are continually investigated, and the choice of treatment often depends on the presence of macular edema or neovascularization.
Glossary definitions and references:
Scientific and Ayurvedic Glossary list for “A Critical Modern Review on BRVO (Branch Retinal Vein Occlusion)�. This list explains important keywords that occur in this article and links it to the glossary for a better understanding of that concept in the context of Ayurveda and other topics.
1) Edema (Oedema):
Oedema is essentially the British spelling of edema. The article discusses macular oedema extensively, which refers to the swelling in the macula due to fluid leakage, a common and vision-impairing complication of BRVO. Various therapies, including laser and anti-VEGF, are evaluated for treatment.
2) Blood:
In the context of BRVO, blood plays a crucial role as the occlusion (blockage) of retinal veins disrupts the normal flow. This leads to various problems like macular edema and hemorrhaging. The study discusses how general cardiovascular diseases affecting blood flow, such as high blood pressure, are risk factors.
3) Disease:
BRVO is classified as a retinal vascular disease. The study explores how systemic vascular diseases like hypertension and atherosclerosis increase the risk of BRVO. Treatments aim to manage the underlying disease mechanisms and associated complications, such as macular edema and neovascularization.
4) Sam (Sham):
In the context of clinical trials on BRVO patients, a sham treatment acts as a placebo. The BRAVO study included a sham injection group to compare the efficacy of ranibizumab in treating macular oedema in BRVO patients, highlighting significant improvements in the treatment group compared to the sham group.
5) Shalakyatantra (Salakyatantra, Shalakya-tantra, Shalakyatamtra):
Shalakya-tantra, represented by Nicole Das [see source text], belongs to the department in Ayurveda dealing with diseases above the clavicle region including ophthalmology, thus making it relevant in the context of BRVO study and treatment.
6) Mutation:
Mutations in genes, such as the factor V Leiden mutation, have been linked to an increased risk of hypercoagulability conditions like BRVO in younger patients. However, the exact association remains controversial, highlighting the need for further studies to produce a definitive link.
7) Swelling:
Swelling is a layman's term for edema or oedema, a primary concern in BRVO. The text refers to macular swelling as a major vision-limiting complication due to fluid leakage from damaged blood vessels, and it requires treatments such as laser therapy and anti-VEGF injections.
8) Tantra (Tamtra, Tantrism):
Tantra in the context of Shalakya-tantra highlights its branch dealing with eye, ENT, and dental diseases within Ayurveda. Faculty from this branch contribute to research and treatments relevant to BRVO due to its focus on ocular diseases.
9) Substance:
Substance refers to the biomolecular agents discussed in treatments for BRVO, such as anti-VEGF agents and steroids. These substances aim to reduce macular edema and inflammation, which are critical for improving patient outcomes.
10) Kumar:
Munna Kumar is mentioned as one of the authors and contributors to the article. He serves as an Assistant Professor in the Shalakya Tantra Department and contributes to the study's findings on treatments and risk factors for BRVO.
11) Urban center (Urban centre):
Urban center mutation refers to factor V Leiden mutation, a genetic variant associated with increased risks of thrombophilia and thus BRVO. The meta-analyses and case studies mentioned explore its relevance in young patients without typical cardiovascular risks.
12) Biodegradable:
The GENEVA study discusses a biodegradable dexamethasone implant used for treating macular edema. This implant, known as Ozurdex, dissolves over time while releasing steroids to reduce swelling and improve vision in BRVO patients.
13) Inflammation:
Inflammation is a body’s response to injury, discussed in the context of BRVO and associated with systemic vasculitides. Chronic inflammation can contribute to retinal vascular blockage, necessitating treatments like steroids to control oedema and prevent further damage.
14) Science (Scientific):
Scientific methods underlie much of the research reviewed in the article, including randomized controlled trials and meta-analyses. These studies are crucial for evaluating the effectiveness of various treatments for BRVO, from anticoagulants to modern anti-VEGF therapies.
15) Patanjali:
Smriti Kaul and Daya Shankar Singh, co-authors of the study, are associated with the PG Department of Shalakya Tantra at Patanjali Bhartiya Ayurvigyan Evum Anusandhan Sansthan in Haridwar, Uttarakhand.
16) Ayurveda (Ayus-veda):
Ayurveda is a traditional Indian medical system, referenced through institutions and researchers contributing to the BRVO study. Concepts from Shalakya-tantra within Ayurveda help in understanding traditional and modern approaches to managing retinal diseases.
17) Smriti (Smrti):
Smriti Kaul is one of the authors of the article, contributing to the research on BRVO. She is an MS Scholar at the PG Department of Shalakya Tantra in Patanjali Bhartiya Ayurvigyan Evum Anusandhan Sansthan.
18) Cancer:
Bevacizumab, an anti-VEGF agent discussed for treating BRVO-related macular edema, is originally an FDA-approved treatment for colon cancer. Its efficacy in reducing vascular complications links its use to ophthalmology for off-label treatments.
19) Animal:
Animal models have been critical in understanding the efficacy of treatments like intravitreal steroids for retinal vascular diseases, including BRVO. These models help in preclinical studies to examine how drugs reduce macular edema before human trials.
20) India:
Various authors and institutions contributing to this study are based in India, including government and private Ayurvedic colleges. India remains a central place for both traditional and modern ophthalmic research converging on diseases like BRVO.
21) Saika:
Saika and coworkers' studies are cited in the context of vitrectomy procedures in BRVO. They showed improvement in macular edema and vision through techniques involving posterior vitreous removal and intraocular gas tamponade.
22) Bihar:
Munna Kumar, one of the authors of the article, serves as Assistant Professor in the Shalakya Tantra Department at Government A S Ayurved College and Hospital in Begusarai, Bihar, India. His contributions are part of the collaborative research on BRVO.
23) Ayus (Ayush):
AYUSH represents the Ministry of Ayurveda, Yoga & Naturopathy, Unani, Siddha, and Homeopathy in India, overseen by contributions that include the journal AYUSHDHARA. Studies like this BRVO review are part of the integrated research efforts in traditional and modern medicine.
24) Daya:
Daya Shankar Singh is listed as an Associate Professor contributing to the research on BRVO in the article. He is affiliated with the Patanjali Bhartiya Ayurvigyan Evum Anusandhan Sansthan at Haridwar, Uttarakhand.
25) Drug:
Drug treatments for BRVO discussed include anti-VEGF agents, steroids like dexamethasone, and intraocular injections such as ranibizumab. These drugs aim to manage complications like macular edema and neovascularization, improving patient visual outcomes.
Other Science Concepts:
Discover the significance of concepts within the article: �A Critical Modern Review on BRVO (Branch Retinal Vein Occlusion)�. Further sources in the context of Science might help you critically compare this page with similair documents:
Longitudinal studies, Atherosclerosis, Visual acuity, Neovascularization, Hypertension, Epidemiological studies, Vascular endothelial growth factor, Optical coherence tomography, Fluorescein angiography, Vitreous hemorrhage, Risk factor, Cystoid Macular Edema, Systemic vascular disease, Branch retinal vein occlusion, Macular edema, Multicenter randomized trial.