RVO treatment: For neovascularization of the retina (NVE) due to RVO, which treatment is indicated?

• A. Sector laser for NVE
• B. PRP
• C. Focal laser only
• D. No laser therapy

Answer: (A)

Neovascularization from retinal vein occlusion is driven by retinal ischemia that stimulates VEGF production. The treatment goal is to reduce the ischemic drive by ablating ischemic retina, which lowers VEGF and allows neovascularization to regress. When the nonperfused area and the neovascular tissue are localized, sector laser photocoagulation targets just those ischemic sectors feeding the neovascularization, providing enough treatment to suppress VEGF with less collateral damage than broader methods. Panretinal photocoagulation is reserved for more extensive retinal nonperfusion, where widespread destruction of ischemic retina is needed. Focal laser alone won’t address the ischemic substrate, and doing nothing risks progression, so sector laser is the indicated approach in this scenario.