RVO treatment: For neovascularization of the iris (NVI) due to RVO, which treatment combination is recommended?

• A. Sector laser alone
• B. Anti-VEGF alone
• C. Sector laser and Anti-VEGF
• D. Pars plana vitrectomy

Answer: (C)

Neovascularization from retinal ischemia in RVO is driven by VEGF, so effective management must both suppress VEGF and reduce the ischemic stimulus. Anti-VEGF injections rapidly cause regression of iris neovascularization and help with macular edema, but addressing the underlying ischemia is needed to prevent recurrence. Laser treatment to ablate or reduce ischemic peripheral retina decreases ongoing VEGF production, providing longer-term control. Using both approaches together tackles the immediate VEGF activity and the persistent ischemic drive, offering better stabilization and lowering the risk of neovascular glaucoma. Pars plana vitrectomy is not the initial choice for this scenario unless complications like persistent vitreous hemorrhage or tractional issues are present.