Retinal Vein Occlusion and Cataract: Treatment Strategies and Current Approaches

Retinal vein occlusion (RVO) is the second most common retinal vascular disease after diabetic retinopathy and a major cause of visual impairment due to macular edema. Cataract, the leading cause of reversible blindness worldwide, frequently coexists with RVO in older adults. The presence of both conditions presents complex therapeutic challenges, as cataract may obscure retinal imaging and limit visual improvement, while intravitreal treatments for RVO—especially corticosteroids—may accelerate cataract progression. Conversely, cataract surgery may trigger or worsen macular edema due to postoperative inflammation. This review outlines the latest evidence and clinical strategies for managing patients with concurrent RVO and cataract. Topics covered include the optimal timing of cataract surgery, the role of anti-VEGF agents and steroid implants in controlling macular edema, and perioperative considerations to reduce the risk of cystoid macular edema (CME). The choice of treatment should be individualized, considering the severity of cataract, the activity of macular edema, and patient-specific visual needs. Preoperative retinal evaluation is essential to distinguish pre-existing RVO-related pathology from postoperative complications. For eyes with ischemic RVO, preoperative control of neovascularization via panretinal photocoagulation and/or anti-VEGF therapy is critical. Surgical strategies may also include the use of perioperative NSAIDs or intraoperative intravitreal injections to reduce postoperative inflammation. In conclusion, a personalized and multidisciplinary approach, involving careful surgical timing and adjunctive retinal therapy, is crucial for achieving favorable anatomical and visual outcomes in patients with both RVO and cataract. Patients should be counseled regarding realistic expectations and the potential need for continued intravitreal therapy after surgery.