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Kumagai K, Ogino N, Fukami M, Furukawa M. Vitrectomy for macular edema due to retinal vein occlusion. Clin Ophthalmol 2019; 13:969-984. [PMID: 31354231 PMCID: PMC6580136 DOI: 10.2147/opth.s203212] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 05/10/2019] [Indexed: 01/19/2023] Open
Abstract
Purpose: To determine the long-term outcomes of vitrectomy for the macular edema associated with a retinal vein occlusion (RVO). Methods: This was a retrospective, consecutive, interventional case series. The intraoperative procedures included internal limiting membrane peeling, arteriovenous sheathotomy, radial optic neurotomy, and intravitreal triamcinolone acetonide injection at the end of the surgery. The main outcome was the best-corrected visual acuity (BCVA). Results: Eight hundred and fifty-four eyes of 854 patients were studied. The eyes consisted of 602 with branch RVO (BRVO), 74 with hemi-central RVO (hemi-CRVO), 87 with nonischemic central retinal vein occlusion (CRVO), and 91 with ischemic CRVO. The mean follow-up period was 68.6 months with a range of 12 to 262 months. The mean BCVA was significantly improved at the final visit (P<0.0001 to 0.0016). The final BCVA improved in 74.4% of the BRVO eyes, in 58.1% of the hemi-CRVO eyes, in 57.4% of the nonischemic CRVO eyes, and in 51.6% of the ischemic CRVO eyes. Multiple regression analysis showed there was no significant relationship between the intraoperative combined procedures and the final BCVA. Conclusions: The results indicate that the type of RVO is significantly associated with the final BCVA, and vitrectomy is a treatment option to improve and maintain BCVA for a long term.
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Affiliation(s)
| | | | - Marie Fukami
- Kami-iida Daiichi General Hospital , Aichi, Japan
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Khayat M, Williams M, Lois N. Ischemic retinal vein occlusion: characterizing the more severe spectrum of retinal vein occlusion. Surv Ophthalmol 2018; 63:816-850. [DOI: 10.1016/j.survophthal.2018.04.005] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2017] [Revised: 04/14/2018] [Accepted: 04/20/2018] [Indexed: 12/15/2022]
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Nishida A, Kojima H, Kameda T, Mandai M, Kurimoto Y. Five-year outcomes of pars plana vitrectomy for macular edema associated with branch retinal vein occlusion. Clin Ophthalmol 2017; 11:369-375. [PMID: 28255227 PMCID: PMC5322837 DOI: 10.2147/opth.s123419] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Purpose Long-term outcomes of pars plana vitrectomy (PPV) for macular edema (ME) associated with branch retinal vein occlusion (BRVO) have been previously reported, but the studies did not report the number of additional treatments after surgery. During 5 years of follow-up, we therefore investigated the efficacy and safety of PPV for BRVO and evaluated the incidence of additional treatments. Methods We retrospectively reviewed the medical records of 25 eyes of 24 patients who underwent PPV for ME associated with BRVO and were followed up for at least 5 years. Best-corrected visual acuity was measured, and foveal thickness was assessed by optical coherence tomography. Additional treatments were also investigated. Results The logarithm of the minimal angle of resolution (logMAR) improved from 0.53±0.23 at baseline to 0.16±0.25 at 5 years (P<0.0001). The foveal thickness decreased from 535±222 µm at baseline to 205±143 µm at 5 years (P<0.0001). For the eyes with residual ME, the following additional treatments were performed within 5 years of follow-up: sub-Tenon injection of triamcinolone acetonide in two eyes, intravitreal injection of bevacizumab in three eyes, grid laser photocoagulation in one eye, and direct photocoagulation of macroaneurysm in one eye. Additional surgeries were performed in two eyes: for one eye, phacoemulsification extraction of the ocular lens and intraocular lens implantation were performed because of cataract progression, and for the other eye, additional PPV was done for postoperative retinal detachment. Conclusion PPV was effective for resolution of ME associated with BRVO and improved visual acuity with a small number of additional treatments during long-term follow-up.
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Affiliation(s)
- Akihiro Nishida
- Department of Ophthalmology, Kobe City Medical Center General Hospital; Department of Ophthalmology, Institute of Biomedical Research and Innovation
| | - Hiroshi Kojima
- Department of Ophthalmology, Kobe City Medical Center General Hospital; Department of Ophthalmology, Institute of Biomedical Research and Innovation
| | - Takanori Kameda
- Department of Ophthalmology, Kobe City Medical Center General Hospital; Department of Ophthalmology, Institute of Biomedical Research and Innovation
| | - Michiko Mandai
- Department of Ophthalmology, Kobe City Medical Center General Hospital; Laboratory for Retinal Regeneration, RIKEN Center for Developmental Biology, Chuo-ku, Kobe, Hyogo, Japan
| | - Yasuo Kurimoto
- Department of Ophthalmology, Kobe City Medical Center General Hospital; Department of Ophthalmology, Institute of Biomedical Research and Innovation
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Keren S, Loewenstein A, Coscas G. Pathogenesis, prevention, diagnosis and management of retinal vein occlusion. World J Ophthalmol 2014; 4:92-112. [DOI: 10.5318/wjo.v4.i4.92] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2014] [Revised: 08/26/2014] [Accepted: 09/17/2014] [Indexed: 02/06/2023] Open
Abstract
Retinal vein occlusion (RVO) is the second vascular retinal cause of visual loss and defined by the occlusion of a retinal vein. It is divided into branch retinal vein occlusion or central retinal vein occlusion, depending on the location of occlusion. RVO has severe medical, financial and social implications on the patients. The diagnosis of the disease is easier nowadays with the use of spectral domain optical coherence tomography and fluorescein angiography. The treatment options for RVO have changed dramatically over the past few years with the introduction of the intravitreal injections of dexamethasone (Ozurdex), bevacizumab (Avastin), ranibizumab (Lucentis) and aflibercept (EYLEA), along with the panretinal laser photocoagulation, abandoning former treatment modalities and surgical solution. This manuscript is a review of current literature about RVO with emphasize on the pathophysiology, risk factors and prevention, diagnosis and sub-group categorization and treatments including medical and surgical. Since no official guidelines are available for the treatment of RVO patients, and considering the latest developments in the treatment options, and the variety of follow-up and treatment modalities, this manuscript aims to provide tools and knowledge to guide the physician in treating RVO patients, based on the latest publications from the literature and on several of the patients characteristics.
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La Spina C, De Benedetto U, Parodi MB, Coscas G, Bandello F. Practical management of retinal vein occlusions. Ophthalmol Ther 2012; 1:3. [PMID: 25135583 PMCID: PMC4108135 DOI: 10.1007/s40123-012-0003-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2012] [Indexed: 11/26/2022] Open
Abstract
Retinal vein occlusion (RVO) is the second most common cause of visual impairment due to retinal disease after diabetic retinopathy. Nowadays, the introduction of new, powerful diagnostic tools, such as spectral domain optical coherence tomography, and the widespread diffusion of intravitreal drugs, such as vascular endothelial grow factor inhibitors or implantable steroids, have dramatically changed the management and prognosis of RVO. The authors aim to summarize and review the main clinical, diagnostic, and therapeutic aspects of this condition. The authors conducted a review of the most relevant clinical trials and observational studies published within the last 30 years using a keyword search of MEDLINE, EMBASE, Current Contents, and Cochrane Library. Furthermore, for all treatments discussed, the level of evidence supporting its use, as per the US Preventive Task Force Ranking System, is provided.
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Affiliation(s)
- Carlo La Spina
- Department of Ophthalmology, Scientific Institute San Raffaele, University Vita-Salute, Via Olgettina, 60, 20132 Milan, Italy
| | - Umberto De Benedetto
- Department of Ophthalmology, Scientific Institute San Raffaele, University Vita-Salute, Via Olgettina, 60, 20132 Milan, Italy
| | - Maurizio Battaglia Parodi
- Department of Ophthalmology, Scientific Institute San Raffaele, University Vita-Salute, Via Olgettina, 60, 20132 Milan, Italy
| | - Gabriel Coscas
- Hôpital Intercommunal de Créteil, Service Universitaire d’ophtalmologie, Créteil, France
| | - Francesco Bandello
- Department of Ophthalmology, Scientific Institute San Raffaele, University Vita-Salute, Via Olgettina, 60, 20132 Milan, Italy
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Aggermann T, Brunner S, Krebs I, Haas P, Womastek I, Brannath W, Binder S. A prospective, randomised, multicenter trial for surgical treatment of central retinal vein occlusion: results of the Radial Optic Neurotomy for Central Vein Occlusion (ROVO) study group. Graefes Arch Clin Exp Ophthalmol 2012; 251:1065-72. [PMID: 22960949 DOI: 10.1007/s00417-012-2134-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2010] [Revised: 06/25/2012] [Accepted: 08/03/2012] [Indexed: 10/27/2022] Open
Abstract
BACKGROUND To compare the surgical outcomes and evaluate the effectiveness of two treatments for central retinal vein occlusion (CRVO), radial optic neurotomy (RON) and intravitreal triamcinolone (IVT), in comparison to natural history. METHODS A prospective, placebo-controlled, randomised and multi-center study. Patients with CRVO were treated in three groups - with either RON, a single intravitreal injection of 4 mg triamcinolone acetonide, or a placebo treatment. The main outcome measures were change of VA (visual acuity) and proportion of eyes with a significant improvement (defined as > 3 lines logMAR scale) of VA from baseline to month 12. RESULTS Ninety patients were included. Due to insufficient data, seven were excluded. Forty-seven percent (n = 18) of patients treated with RON showed an increase in VA, in comparison to 10 % (n = 2) of placebo-treated patients, and 20 % (n = 5) of patients treated with IVT. Significantly more patients showed an improvement in VA following RON than in the placebo group (p = 0.009). Significantly more patients showed an improvement in VA following RON than in the IVT group (p = 0.034). No significant difference was found when directly comparing improvement in VA following IVT and placebo (p = 0.667) treatment.Significantly (p = 0.007) more patients in the placebo group (35 %, n = 7) showed a deterioration (defined as > 3 lines LogMAR scale) in VA than patients in the RON group (8 %, n = 3). CONCLUSION Our study showed that following treatment with RON, patients with CRVO display a significantly better long-term VA than untreated patients and patients treated with a single dose of IVT.
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Affiliation(s)
- Tina Aggermann
- Department of Ophthalmology, Rudolf Foundation Clinic, Juchgasse 25, 1030 Vienna, Austria.
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Belforte N, Sande PH, de Zavalía N, Dorfman D, Rosenstein RE. Therapeutic benefit of radial optic neurotomy in a rat model of glaucoma. PLoS One 2012; 7:e34574. [PMID: 22479647 PMCID: PMC3315541 DOI: 10.1371/journal.pone.0034574] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2011] [Accepted: 03/05/2012] [Indexed: 11/18/2022] Open
Abstract
Radial optic neurotomy (RON) has been proposed as a surgical treatment to alleviate the neurovascular compression and to improve the venous outflow in patients with central retinal vein occlusion. Glaucoma is characterized by specific visual field defects due to the loss of retinal ganglion cells and damage to the optic nerve head (ONH). One of the clinical hallmarks of glaucomatous neuropathy is the excavation of the ONH. The aim of this work was to analyze the effect of RON in an experimental model of glaucoma in rats induced by intracameral injections of chondroitin sulfate (CS). For this purpose, Wistar rats were bilaterally injected with vehicle or CS in the eye anterior chamber, once a week, for 10 weeks. At 3 or 6 weeks of a treatment with vehicle or CS, RON was performed by a single incision in the edge of the neuro-retinal ring at the nasal hemisphere of the optic disk in one eye, while the contralateral eye was submitted to a sham procedure. Electroretinograms (ERGs) were registered under scotopic conditions and visual evoked potentials (VEPs) were registered with skull-implanted electrodes. Retinal and optic nerve morphology was examined by optical microscopy. RON did not affect the ocular hypertension induced by CS. In eyes injected with CS, a significant decrease of retinal (ERG a- and b-wave amplitude) and visual pathway (VEP N2-P2 component amplitude) function was observed, whereas RON reduced these functional alterations in hypertensive eyes. Moreover, a significant loss of cells in the ganglion cell layer, and Thy-1-, NeuN- and Brn3a- positive cells was observed in eyes injected with CS, whereas RON significantly preserved these parameters. In addition, RON preserved the optic nerve structure in eyes with chronic ocular hypertension. These results indicate that RON reduces functional and histological alterations induced by experimental chronic ocular hypertension.
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Affiliation(s)
- Nicolás Belforte
- Laboratory of Retinal Neurochemistry and Experimental Ophthalmology, Department of Human Biochemistry, School of Medicine/CEFyBO, University of Buenos Aires, CONICET, Buenos Aires, Argentina
| | - Pablo H. Sande
- Laboratory of Retinal Neurochemistry and Experimental Ophthalmology, Department of Human Biochemistry, School of Medicine/CEFyBO, University of Buenos Aires, CONICET, Buenos Aires, Argentina
| | - Nuria de Zavalía
- Laboratory of Retinal Neurochemistry and Experimental Ophthalmology, Department of Human Biochemistry, School of Medicine/CEFyBO, University of Buenos Aires, CONICET, Buenos Aires, Argentina
| | - Damián Dorfman
- Laboratory of Retinal Neurochemistry and Experimental Ophthalmology, Department of Human Biochemistry, School of Medicine/CEFyBO, University of Buenos Aires, CONICET, Buenos Aires, Argentina
| | - Ruth E. Rosenstein
- Laboratory of Retinal Neurochemistry and Experimental Ophthalmology, Department of Human Biochemistry, School of Medicine/CEFyBO, University of Buenos Aires, CONICET, Buenos Aires, Argentina
- * E-mail:
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Abstract
BACKGROUND Radial optic neurotomy (RON) has been proposed as a treatment for central retinal vein occlusion. However, it is still under debate whether RON would be an adequate treatment or a dangerous procedure, and persuasive animal studies are lacking. The aim of this study was to analyze the early histologic and functional outcomes of RON in normal rat eyes. METHODS Radial optic neurotomy was performed by cutting into the optic nerve edge at the nasal hemisphere, while the contralateral eye underwent a sham procedure. The retinal function was assessed by scotopic electroretinography, and the visual pathway was assessed by flash visual evoked potentials. Intraocular pressure was assessed with a tonometer, the pupillary light reflex was measured after exposing eyes to a 30-second light flash, whereas the optic nerve head structure was examined by histologic analysis. RESULTS In normal rat eyes, RON provoked minor histologic alterations at the optic nerve head level and a transient decrease in the electroretinography. No changes in visual evoked potentials, intraocular pressure, and pupillary light reflex were observed in rat eyes submitted to RON. CONCLUSION To our knowledge, this is the first study describing the early histopathologic and functional consequences of RON in normal rat eyes.
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E. Rosenstein R, Belforte N. Radial optic neurotomy: a new surgical approach for glaucoma treatment? MEDICAL HYPOTHESIS, DISCOVERY & INNOVATION OPHTHALMOLOGY JOURNAL 2012; 1:52-6. [PMID: 24600623 PMCID: PMC3939732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Glaucoma is a leading cause of blindness worldwide, characterised by specific visual field defects due to the degeneration of retinal ganglion cells and damage to the optic nerve head (ONH). Elevated intraocular pressure (IOP) is the most important risk factor for glaucoma development. One of the clinical hallmarks of glaucomatous optic neuropathy is the excavation of the ONH, which consists of a progressive posterior displacement of the ONH surface and excavation of the pre-laminar tissues beneath the anterior-most aspect of the scleral canal, known as the anterior scleral ring. Radial optic neurotomy (RON) is a surgical technique that has been proposed for treating central retinal vein occlusion. While the original rationale of RON was the relief of increased tissue pressure within the optic nerve that results from occlusion of the central retinal vein, recent results are discussed here which suggest that by relaxing of the scleral ring of the prelaminar and laminar regions of the ONH, RON may alleviate the IOP-related connective tissue stress, and in turn, prevent the onset and reduce the progression of glaucomatous neuropathy.
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Affiliation(s)
- Ruth E. Rosenstein
- Laboratory of Retinal Neurochemistry and Experimental Ophthalmology, Department of Human Biochemistry, School of Medicine, University of Buenos Aires/CEFyBO, CONICET, Buenos Aires, Argentina
| | - Nicolás Belforte
- Laboratory of Retinal Neurochemistry and Experimental Ophthalmology, Department of Human Biochemistry, School of Medicine, University of Buenos Aires/CEFyBO, CONICET, Buenos Aires, Argentina
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Coscas G, Loewenstein A, Augustin A, Bandello F, Battaglia Parodi M, Lanzetta P, Monés J, de Smet M, Soubrane G, Staurenghi G. Management of retinal vein occlusion--consensus document. ACTA ACUST UNITED AC 2011; 226:4-28. [PMID: 21577038 DOI: 10.1159/000327391] [Citation(s) in RCA: 88] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Retinal vein occlusion (RVO) can have severe consequences for the people affected by the disease, including visual loss with costly social repercussions. Currently, there is no European consensus with regard to the management of RVO. Following a careful review of the medical literature as well as the data from several clinical trials, a collaborative group of retina specialists put forth practical recommendations based on the best available scientific evidence for the clinical approach to RVO. Taking into consideration the recent advances in diagnostic tools and management options, the present document aims to provide the European ophthalmologists with guidelines for clinical practice to the benefit of their patients.
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Affiliation(s)
- Gabriel Coscas
- Hôpital Intercommunal de Créteil, Service Universitaire d'Ophtalmologie, Créteil, France.
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The Central Retinal Vein Bypass Study: A Trial of Laser-induced Chorioretinal Venous Anastomosis for Central Retinal Vein Occlusion. Ophthalmology 2010; 117:954-65. [DOI: 10.1016/j.ophtha.2009.10.026] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2009] [Revised: 10/09/2009] [Accepted: 10/13/2009] [Indexed: 11/23/2022] Open
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COMPARISON OF SURGICAL TREATMENTS FOR CENTRAL RETINAL VEIN OCCLUSION; RON VS. CANNULATION OF TISSUE PLASMINOGEN ACTIVATOR INTO THE RETINAL VEIN. Retina 2009; 29:1167-74. [DOI: 10.1097/iae.0b013e3181a46a5e] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Ultrastructural analysis of the lamina cribrosa after radial optic neurotomy. Ann Anat 2009; 191:267-72. [PMID: 19450956 DOI: 10.1016/j.aanat.2009.02.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2009] [Accepted: 02/12/2009] [Indexed: 01/01/2023]
Abstract
Radial optic neurotomy (RON) has been proposed for alleviation of the "scleral outlet compartment syndrome" at the level of the lamina cribrosa, which is thought to play a pathoetiologic role in central retinal vein occlusion (CRVO). The aim of this study has been to analyze the ultrastructural alterations of the lamina cribrosa after RON to gain new insights in the underlying pathomechanical factors. Fifteen donor eyes underwent a standardized open-sky-vitrectomy and RON after removal of the anterior eye segment for keratoplasty. Using a microvitreoretinal blade, a radial incision was performed on the nasal hemisphere of the optic nerve head radial to the optic disc and parallel to the nerve fibre layer. The lamina cribrosa and the surrounding scleral ring were then prepared for light microscopy, scanning (SEM) and transmission electron microscopy (TEM). Ultrastructural analysis demonstrated that in 60% (n=9) of the evaluated cases the scleral ring was dissected completely and in 40% (n=6) only partially. The adjacent neuronal tissue to the dissection area showed only minimal injury. The central retinal vessels were not injured in all cases. Only complete incision of the circular ring of collagen fibrils surrounding the lamina cribrosa via RON resulted in effective relaxation of the scleral outlet and was achieved in 60% of all eyes under standardized conditions. In all cases the adjacent tissue showed only minimal injury. The high rate of incomplete dissection of the scleral outlet may be an explanation for the variable outcome seen in different studies on RON.
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Williamson TH, Grewal J, Gupta B, Mokete B, Lim M, Fry CH. Measurement of PO2 during vitrectomy for central retinal vein occlusion, a pilot study. Graefes Arch Clin Exp Ophthalmol 2009; 247:1019-23. [PMID: 19347349 DOI: 10.1007/s00417-009-1072-z] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2009] [Revised: 03/09/2009] [Accepted: 03/11/2009] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION In this pilot study the effects of vitrectomy on PO(2) in the vitreous cavity in CRVO were investigated. STUDY DESIGN Prospective, controlled, interventional study. METHOD Six patients with ischaemic CRVO in one eye (undergoing vitrectomy for radial optic neurotomy, RON) and six with either macula hole or membrane were included. An oxygen probe was inserted before removal of the vitreous (pre-vitrectomy) and after removal of the vitreous (post-vitrectomy). In the patients with CRVO, measurements were taken before RON was performed. Oxygenation recordings (PO(2)) were taken in the mid-vitreous cavity and the preretinal vitreous. RESULTS Mean age was 65 years. In controls, pre-vitrectomy, the mean PO(2) adjacent to the retina (15.0 mmHg S.D.5.7) was significantly less than mid-cavity (33.7 mmHg S.D.12.8). Similarly in CRVO, the pre-vitrectomy pre-retinal PO(2) (8.1 mmHg S.D. 3.5), was significantly less than mid-cavity (19.8 mmHg S.D.7.3). The mean PO(2) was significantly less in the eyes with CRVO than in control eyes. Post-vitrectomy, the PO(2) was significantly greater than pre-vitrectomy at both recording sites in the controls mid-cavity (61.5 mmHg S.D.13.9) and pre-retinal (75.8 mmHg S.D. 9.1), and CRVO eyes mid-cavity (53.7 mmHg S.D. 17.9) and pre-retinal (59.8 mmHg S.D. 15.8). CONCLUSION PO(2) is reduced in the vitreous cavity in CRVO. Vitrectomy may be a method of increasing oxygen availability to the retina.
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Affiliation(s)
- Tom H Williamson
- Department of Ophthalmology, St. Thomas Hospital, Lambeth Palace Road, London, SE1 7EH, UK.
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Abstract
The treatment of central retinal vein occlusion (CRVO) is still a subject of debate. Medical therapy efforts, as well as retinal laser photocoagulation, have mostly dealt with management of the sequelae of CRVO, and have shown limited success in improving visual acuity. The unsatisfactory results of such therapeutic efforts led to the development of new treatment strategies focused on the surgical treatment of the occluded retinal vein. The purpose of this review is to summarize the outcomes of commonly reported surgical treatment strategies and to review different opinions on the various surgical approaches to the treatment of CRVO.
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Affiliation(s)
- Nilufer Berker
- Department of Vitreoretinal Surgery, Ulucanlar Eye Research Hospital, Ankara, Turkey.
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Induction of retinochoroidal venous anastomosis in central retinal vein occlusion with macular edema via a full-thickness retinochoroidal incision. Retina 2008; 28:477-84. [PMID: 18327142 DOI: 10.1097/iae.0b013e31815ec317] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To report the induction of retinochoroidal venous anastomosis (RCVA) in the treatment of nonischemic central retinal vein occlusion (CRVO) with macular edema via a full-thickness retinochoroidal incision. METHODS In nine eyes with nonischemic CRVO and intractable macular edema, one or two full-thickness incisions transacting a major retinal branch vein to the level of inner sclera were made in conjunction with vitrectomy. Fluorescein angiography was conducted to evaluate the formation of functional RCVA. Best-corrected visual acuity (BCVA) and central macular thickness (CMT) were compared before and after the surgery. RESULTS The mean follow-up period +/- SD was 12.0 +/- 5.1 months. All nine eyes developed functional RCVA after the surgery. The mean BCVA +/- SD improved from 0.75 +/- 0.30 logMAR (logarithm of the minimal angle of resolution) to 0.55 +/- 0.26 logMAR (P = 0.018), and the mean CMT +/- SD was reduced from 686 +/- 265 microm to 251 +/- 150 microm (P = 0.011). Additional surgery was performed on one eye due to persistent vitreous hemorrhage. CONCLUSION Full-thickness retinochoroidal incision appears to raise the rate of successful RCVA formation and may improve the outcome of CRVO with macular edema.
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Hasselbach HC, Ruefer F, Feltgen N, Schneider U, Bopp S, Hansen LL, Hoerauf H, Bartz-Schmidt U, Roider J. Treatment of central retinal vein occlusion by radial optic neurotomy in 107 cases. Graefes Arch Clin Exp Ophthalmol 2008; 245:1145-56. [PMID: 17219118 DOI: 10.1007/s00417-006-0501-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2006] [Accepted: 11/14/2006] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND To evaluate the potential role of radial optic neurotomy (RON), a new surgical technique has been recently proposed for treating central retinal vein occlusion (CRVO). It is hypothesized that CRVO constitutes a neurovascular compartment syndrome at the site of the lamina cribrosa, which can be alleviated by performing a radial incision at the nasal part of the optic nerve head, relaxing the cribriform plate and the adjacent sclera. METHODS One hundred and seven patients were treated with RON for CRVO at five collaborating ophthalmologic centers. All patients were evaluated by a standardized protocol. For analysis of the angiographic and fundus findings, reference images were used. Intraoperative and postoperative complications were reviewed. RESULTS On 55 right and 52 left eyes of 107 patients (55.6% male, 44.4% female) with a median age of 68 years (range 21-91 years), RON was performed. The median follow-up time was 6 months (range 1-24 months). The median preoperative visual acuity (VA) was 0.05 (logMAR 1.3), increasing to a median postoperative VA of 0.08 (logMAR 1.1). Patients with an interval of more than 90 days between RON and onset of CRVO showed no significant change in VA at the 6-month follow-up. Severe peripapillary swelling of the optic nerve head prior to RON resulted in an average increase of 4.2 lines in VA at the 6-month follow-up. Angiographic findings of shunt vessels were seen in 18/30 cases after 12 months and were accompanied by an average improvement of VA of six lines. Visual field tests showed various defects in 86.8% of all cases. In one patient an iatrogenic injury of the central retinal artery occurred (0.9%). CONCLUSION Despite the potential risk of visual field defects, RON seems to be a quite safe procedure. The majority of patients showed rapid normalization of the morphologic fundus findings, with an improvement in VA uncommon for the natural history of CRVO. No significant change in VA was seen in patients with an interval of more than 90 days between the onset of CRVO and RON. A prospective study is warranted for further investigation.
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Affiliation(s)
- H C Hasselbach
- Department of Ophthalmology, University Hospital Schleswig-Holstein, Campus Kiel, Hegewischstr. 2, 24105 Kiel, Germany.
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Seo HC, Cho NC, Ahn M, Kweon EY. Retinal Choroidal Collateral Circulation After Radial Optic Neurotomy for Central Retinal Vein Occlusion. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2008. [DOI: 10.3341/jkos.2008.49.3.456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Hee Chun Seo
- Department of Ophthalmology, Chonbuk National University, College of Medicine, Chonbuk, Korea
| | - Nam Chun Cho
- Department of Ophthalmology, Chonbuk National University, College of Medicine, Chonbuk, Korea
| | - Min Ahn
- Department of Ophthalmology, Chonbuk National University, College of Medicine, Chonbuk, Korea
| | - Eui-Yong Kweon
- Department of Ophthalmology, Chonbuk National University, College of Medicine, Chonbuk, Korea
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Chang YC, Wu WC. Intravitreal triamcinolone acetonide for the management of papillophlebitis and associated macular edema. Int Ophthalmol 2007; 28:291-6. [PMID: 17701380 DOI: 10.1007/s10792-007-9128-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2007] [Accepted: 07/11/2007] [Indexed: 10/23/2022]
Abstract
BACKGROUND To investigate the efficacy of intravitreal injection of triamcinolone acetonide in the management of papillophlebitis and associated cystoid macular edema. METHODS This study was a retrospective medical records review of four eyes of four patients (three males and one female) who had approximately 2-4 months history of papillophlebitis and associated persistent cystoid macular edema. These patients were treated with a single intravitreal injection of 4 mg triamcinolone acetonide. Mean follow-up time was 15 +/- 4 months. The outcome measures included best corrected visual acuity (BCVA), intraocular pressure (IOP), and central retinal thickness by optical coherence tomography (OCT). RESULTS The BCVA ranged from 20/100 to 20/60 pre-operation. The mean gain in BCVA was 7 +/- 1 Snellen lines. All eyes had BCVA of 20/20 at the last visit. The mean baseline central retinal thickness as measured by OCT was 529 +/- 53 microm. The mean central retinal thickness by OCT was 235 +/- 15 microm at 1-week follow-up examination. At the last visit the mean central retinal thickness by OCT was 161 +/- 7 microm. One patient experienced an increase in IOP after the first injection and another patient had IOP elevation after the second injection. Both were well controlled with single topical anti-glaucoma medication. CONCLUSION Intravitreal injection of triamcinolone acetonide appears to be an effective treatment for patients with papillophlebitis and associated cystoid macular edema.
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Affiliation(s)
- Yo-Chen Chang
- Department of Ophthalmology, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
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22
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Hirano Y, Sakurai E, Yoshida M, Ogura Y. Comparative study on efficacy of a combination therapy of triamcinolone acetonide administration with and without vitrectomy for macular edema associated with branch retinal vein occlusion. Ophthalmic Res 2007; 39:207-12. [PMID: 17596753 DOI: 10.1159/000104682] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2006] [Accepted: 03/17/2007] [Indexed: 11/19/2022]
Abstract
AIMS To compare the efficacy ofa combination therapy of triamcinolone acetonide (TA) administration with and without vitrectomy in eyes with macular edema associated with branch retinal vein occlusion over a 1-year period. METHODS A retrospective, case-control study was conducted in 15 eyes of 15 patients with macular edema associated with branch retinal vein occlusion. Eight eyes underwent simultaneous intravitreal and posterior sub-Tenon capsule injections of TA (TA-injected group). Seven eyes underwent vitrectomy with intravitreal or simultaneous posterior sub-Tenon capsule injection of TA (vitrectomy with TA group). Macular thickness and visual acuity were measured before and at 1, 3, 6 and 12 months after the therapy. RESULTS Twelve months after the therapy, mean visual acuity improved significantly from baseline in both the TA-injected (p = 0.0069) and vitrectomy with TA groups (p = 0.0145). Macular thickness also improved significantly in both the TA-injected (p = 0.0065) and vitrectomy with TA groups (p = 0.0058). At 12 months after the therapy, there was no significant difference in visual acuity and macular thickness between the two groups (p = 0.3308 and 0.3711, respectively). At the early postoperative stage (1 and 3 months after the therapy), the central macular thickness in the TA-injected group was significantly less than that in the vitrectomy with TA group (p = 0.0140 and 0.0275, respectively); there was no significant difference in visual acuity between the two groups (p = 0.0796 and 0.3753, respectively). CONCLUSION TA injection without vitrectomy was as effective as a combination therapy of TA injection with vitrectomy.
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Affiliation(s)
- Yoshio Hirano
- Department of Ophthalmology and Visual Science, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.
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Binder S, Aggermann T, Brunner S. Long-term effects of radial optic neurotomy for central retinal vein occlusion consecutive interventional case series. Graefes Arch Clin Exp Ophthalmol 2007; 245:1447-52. [PMID: 17406885 DOI: 10.1007/s00417-007-0565-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2006] [Revised: 02/10/2007] [Accepted: 02/17/2007] [Indexed: 11/28/2022] Open
Abstract
PURPOSE To investigate the long-term (minimum 24 months follow-up) clinical results of radial optic neurotomy (RON) following a pars plana vitrectomy (PPV) with internal limiting membrane peeling as treatment for central retinal vein occlusion (CRVO). METHODS Interventional case series of 14 consecutive patients (14 eyes) with CRVO who were treated with a PPV combined with RON within 1 year of diagnosis. RESULTS Median baseline visual acuity (VA) was 1.05 logMAR (approximately 0.09 Snellen) in the affected eye. The follow-up period ranged from 24 to 48 months postoperatively, median 30 months. At the 24-month follow-up examination, median VA was 1.005 logMAR in the affected eye-a significant improvement (p = 0.013). Six patients (43%) gained 1 or more lines of VA (mean VA gain = 1.7 lines), while the VA of four patients (29%) improved by 3 or more lines. The eyes with nonischemic CRVO demonstrated a significantly higher improvement in VA (p = 0.0007) than the eyes with ischemic CRVO. CONCLUSION With RON clinically relevant improvements on a long-term basis seem achievable. Patients with nonischemic CRVO may respond more favorably than patients with ischemic CRVO.
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Affiliation(s)
- Susanne Binder
- Department of Ophthalmology, The Ludwig Boltzmann Institut for Retinology and Biomicroscopic Laser Surgery, Rudolf Foundation Clinic, Vienna, Austria.
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Abstract
The range of therapeutic options for the treatment of retinal vein occlusions has been decisively extended by three new surgical methods: radial optic neurotomy (RON) and retinal endovascular lysis (REVL) for central retinal vein occlusion, and arteriovenous dissection (AVD/sheathotomy) for branch retinal vein occlusion. None of those methods has been tested in randomised studies meeting the requirements of evidence-based medicine. It is therefore difficult to assess the relative values of the individual procedures and determine in what precise circumstances each is indicated. The difficulties are compounded further by the use of these techniques in association with new and promising intravitreally injected drugs (e.g. steroids and angioinhibitors), which makes it even more difficult to assess the real efficacy of the surgical methods. In this paper we discuss the three different surgical methods and try to evaluate their clinical benefit.
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Affiliation(s)
- N Feltgen
- Universitätsaugenklinik Freiburg, Killianstrasse 5, 79106, Freiburg, Deutschland.
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25
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Furukawa M, Kumagai K, Ogino N, Uemura A, Larson E. Long-term visual outcomes of vitrectomy for cystoid macular edema due to nonischemic central retinal vein occlusion. Eur J Ophthalmol 2007; 16:841-6. [PMID: 17191190 DOI: 10.1177/112067210601600609] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
PURPOSE To report the long-term surgical outcome of vitrectomy for cystoid macular edema due to nonischemic central retinal vein occlusion (CRVO). METHODS A retrospective chart review of 25 consecutive eyes (25 patients) with cystoid macular edema due to nonischemic CRVO treated with vitrectomy was performed. All patients underwent a pars plana vitrectomy with the creation of a posterior vitreous detachment if still attached. Simultaneous phacoemulsification with intraocular lens implantation was also performed in phakic eyes. The main outcome measures were best-corrected visual acuity (BCVA) and changes in macular edema shown by contact-lens biomicroscopy. The mean follow-up time was 49 months (range, 16-108). RESULTS The median BCVA before surgery was 0.31 and the median BCVA at last follow-up was 0.67. The BCVA at the last follow-up improved at least two Snellen lines in 17 (68%), remained unchanged in 4 (16%), and worsened in 4 (16%). The BCVA was 20/40 or better in 3 eyes (12%) preoperatively and in 18 eyes (72%) at the last follow-up. During the follow-up, four patients progressed to ischemic CRVO; one of them had neovascular glaucoma requiring surgical intervention. CONCLUSION The data indicate that vitrectomy appears to be a possibly effective treatment in some eyes with cystoid macular edema associated with nonischemic CRVO.
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Affiliation(s)
- M Furukawa
- Department of Ophthalmology, Kami-iida First General Hospital, Nagoya, Japan
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Mandelcorn MS, Mandelcorn E, Guan K, Adatia FA. Surgical macular decompression for macular edema in retinal vein occlusion. Can J Ophthalmol 2007. [DOI: 10.3129/can.j.ophthalmol.06-091] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
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Williamson TH. A "throttle" mechanism in the central retinal vein in the region of the lamina cribrosa. Br J Ophthalmol 2006; 91:1190-3. [PMID: 17005545 PMCID: PMC1954902 DOI: 10.1136/bjo.2006.102798] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
AIMS To demonstrate a constriction in the central retinal vein in the region of the lamina cribrosa. METHODS A prospective comparative interventional study of 13 controls and 19 patients with central retinal vein occlusion (CRVO) using colour Doppler imaging of the central retinal artery and vein in the region of the lamina cribrosa and optic nerve posterior to the globe. RESULTS In controls peak velocities in the vein were higher in the region of the lamina cribrosa than the optic nerve, mean 175 mm/second (mm/s) and 49 mm/s respectively, p<0.0001. The velocities in the artery were also higher in the region of the lamina cribrosa, mean 122 mm/s and 92 mm/s, p = 0.007. The variability of the velocities in the region of the lamina cribrosa was 7.4% in the artery and 15.2% in the vein. The mean ratio of the velocities in the vein (4.2 (SD 2.1)) was significantly higher than the mean ratio in the artery (1.4 (SD 0.4), p<0.0001). In CRVO, the mean ratio in the vein was lower in the affected eyes (2.2 (SD 1.9), p<0.01) and fellow unaffected eyes (2.2 (SD 1.0), p = 0.003) than controls. The values were stable in eight after radial optic neurotomy. CONCLUSION The presence of a constriction of the vein in the region of the lamina cribrosa can be inferred from the presence of higher blood velocities at this site than further back in the optic nerve. In CRVO there may be a more uniform narrowing of the vein along its course in the nerve. Neurotomy did not affect the measurements.
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Affiliation(s)
- Tom H Williamson
- Department of Ophthalmology, St Thomas' Hospital, Lambeth Palace Road, London SE1 7NH, UK.
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Sakaguchi H, Ohji M, Kamei M, Ikuno Y, Fukushima Y, Gomi F, Oshima Y, Kusaka S, Tano Y. Radial optic neurotomy for the management of hemicentral retinal vein occlusion: long-term follow-up study. Retina 2006; 26:555-61. [PMID: 16770263 DOI: 10.1097/00006982-200605000-00010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To assess the efficacy of radial optic neurotomy (RON) for hemicentral retinal vein occlusion (hemi-CRVO) in patients with follow-up of >12 months. METHODS Five consecutive patients with hemi-CRVO were enrolled in the study and underwent vitrectomy with RON. The effects of this treatment were assessed by visual acuity, optical coherence tomography, indocyanine green angiography, and kinetic visual field testing. RESULTS The median and mean visual acuities improved from 20/250 to 20/50 and from 20/286 to 20/51, respectively. Four patients (80%) had visual acuity improvement of > or =3 lines; visual acuity in 1 patient (20%) remained the same. Visual acuity in all four eyes with preoperative visual acuity of <20/200 improved to >20/200 12 months after surgery. Foveal thickness was gradually reduced during the follow-up period. Chorioretinal anastomosis was detected by indocyanine green angiography in 3 eyes (60%). A temporal visual field defect was found in two eyes. No neovascularization on the iris, angle, optic disk, or retina was detected postoperatively. CONCLUSION Visual acuity may improve more with RON compared with the natural history of the disease, and no neovascular formation may occur after RON, suggesting that this procedure may be an effective treatment for hemi-CRVO.
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Affiliation(s)
- Hirokazu Sakaguchi
- Department of Ophthalmology, Osaka University Medical School, Suita, Japan.
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Shahid H, Hossain P, Amoaku WM. The management of retinal vein occlusion: is interventional ophthalmology the way forward? Br J Ophthalmol 2006; 90:627-39. [PMID: 16622095 PMCID: PMC1857058 DOI: 10.1136/bjo.2005.068668] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 12/09/2005] [Indexed: 11/03/2022]
Abstract
Retinal vein occlusions (RVO) are the second commonest sight threatening vascular disorder. Despite its frequency treatments for RVO are unsatisfactory and include several that have not been tested by large, well designed, prospective, randomised controlled trials. There is also the lack of long term follow up in many of the available small uncontrolled studies, and the timings of interventions are haphazard. This review aims to evaluate the current knowledge relating to the pathogenesis, suggested treatments for the different types of RVO, and their complications. Isovolaemic haemodilution is of limited benefit and should be avoided in patients with concurrent cardiovascular, renal, or pulmonary morbidity. Evidence to date does not support any therapeutic benefit from radial optic neurotomy, optic nerve decompression, or arteriovenous crossing sheathotomy on its own. Vitrectomy combined with intravenous thrombolysis may offer promise for central RVO. Similarly, vitrectomy combined with arteriovenous sheathotomy intravenous tissue plasminogen activator may offer benefits for branch RVO. RVOs occur at significantly high frequency to allow future prospective randomised controlled studies to be conducted to evaluate the role of different therapeutic modalities singly or in combination.
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Affiliation(s)
- H Shahid
- Prince Charles Eye Unit, King Edward VII Hospital, Windsor, UK
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Barak A, Kesler A, Gold D, Loewenstein A. VISUAL FIELD DEFECTS AFTER RADIAL OPTIC NEUROTOMY FOR CENTRAL RETINAL VEIN OCCLUSION. Retina 2006; 26:549-54. [PMID: 16770262 DOI: 10.1097/00006982-200605000-00009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE Surgical decompression of the vein in central retinal vein occlusion (CRVO) by radial optic neurotomy (RON) was recently proposed as being surgically feasible, safe, and beneficial. The effect of RON on the visual field has not been systematically reported, although possible visual field defects are expected due to iatrogenic cutting of the optic nerve fibers. The authors report the results of visual field testing in patients who underwent RON at the Tel Aviv Medical Center. METHODS Twelve consecutive patients (8 men, mean age of all patients 68 years) with nonperfused or indeterminate CRVO whose initial visual acuity (VA) was < or =20/400 underwent RON. Nine of these patients were able to perform visual field tests at 6 months post-RON and their visual field results are presented. RESULTS : VA improved by > or =3 lines in 5 patients (42%). Three (25%) patients had a final VA of > or =20/200 and another had a final VA > or =20/50. Fundus and VA improvement were relatively slow. Two patients had clearing of the intraretinal blood, resolution of the venous dilation, and improved VA at the 2-month follow-up visit. Temporal visual field defects consisting of temporal ones that could be correlated to the site of the RON incision were detected in five out of the nine patients who were able to perform visual field tests. No temporal visual field defects were found in the remaining four patients, and three other patients were unable to perform visual field tests due to inability to identify the largest target size. CONCLUSION VA improvement in 5 of 12 patients with ischemic or indeterminate CRVO following RON may be better than the natural history of CRVO. The risk of visual field defects may, however, be heightened by possibly cutting off blood supply to the optic nerve head and possible damage to nerve fibers in the optic nerve head, both inherent to the surgical procedure and both likely to produce visual loss.
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Affiliation(s)
- Adiel Barak
- Department of Ophthalmology, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Israel.
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Tsujikawa A, Hangai M, Kikuchi M, Ishida K, Kurimoto Y. Visual Field Defect After Radial Optic Neurotomy for Central Retinal Vein Occlusion. Jpn J Ophthalmol 2006; 50:158-60. [PMID: 16604393 DOI: 10.1007/s10384-005-0286-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2005] [Accepted: 05/23/2005] [Indexed: 11/27/2022]
Abstract
PURPOSE To evaluate visual field defects after radial optic neurotomy (RON) in eyes with central retinal vein occlusion (CRVO). METHODS Eight patients (eight eyes) underwent RON for macular edema associated with CRVO. Goldmann perimetry was performed on each patient both before and after surgery. RESULTS Postoperative Goldmann perimetry showed a temporally located wedge-shaped visual field defect consistent with neural damage secondary to RON in seven eyes (88%). After surgery, the visual field decreased from preoperative values by 7% at 3 months (P = 0.30) and by 21% at 12 months (P = 0.0023). Although three patients (38%) were aware of the postoperative visual field defect, only one patient (13%) considered this defect to be a visual disability. CONCLUSIONS After RON, most patients showed a postoperative defect in the temporal visual field consistent with the incision to the optic disk. However, this visual field defect appears to be well tolerated by most patients.
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Affiliation(s)
- Akitaka Tsujikawa
- Department of Ophthalmology, Kobe City General Hospital, Kobe, Japan.
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Wrede J, Varadi G, Völcker HE, Dithmar S. Wie tief muss die radiäre Optikusneurotomie zur Therapie des retinalen Zentralvenenverschlusses sein? Ophthalmologe 2006; 103:321-4. [PMID: 16328486 DOI: 10.1007/s00347-005-1281-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
PURPOSE Most of the studies on radial optic neurotomy (RON) have not defined the depth of the incision. Complications following a deeper incision have been described. This histological study was performed to evaluate the required depth for RON. METHODS Serial sections of the area of the optic nerve head were performed in 19 eye bank eyes. The distance between the inner surface of the optic disc and the outer limit of the cribriform plate was measured. Ten additional eye bank eyes underwent 2 mm deep experimental RON using the Spaide CRVO Knife (DORC, Netherlands). The cutting depth was assessed histologically by serial cuts. RESULTS The distance between the inner surface of the disc and the outer limit of the cribriform plate measured 1.35+/-0.3 mm (shrinkage-revised value: 1.45 mm). The experimental RON showed cutting depths of 1.53+/-0.3 mm (shrinkage-revised value: 1.65 mm). CONCLUSION Based on normal eyes, a cutting depth of 1.45 mm is sufficient to cut through the cribriform plate. This might change during central retinal vein occlusion because possible papillary edema due to central retinal vein occlusion has to be considered. Even under controlled experimental conditions RON leads to great variation in incision depths. The development of a knife with a fixed penetration depth would be helpful.
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Affiliation(s)
- J Wrede
- Augenklinik, Universität, Heidelberg.
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Kim TW, Lee SJ, Kim SD. Comparative evaluation of radial optic neurotomy and panretinal photocoagulation in the management of central retinal vein occlusion. KOREAN JOURNAL OF OPHTHALMOLOGY 2006; 19:269-74. [PMID: 16491816 DOI: 10.3341/kjo.2005.19.4.269] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE There is currently no treatment proven effective for central retinal vein occlusion (CRVO). Radial optic neurotomy (RON) has recently surfaced as a new treatment for the disorder, however, and we compare here the visual acuity (VA) and arteriovenous transit time (AVTT) following RON and panretinal photocoagulation (PRP). METHODS We conducted a retrospective, uncontrolled study of 27 patients. Of 27 eyes diagnosed with CRVO, 16 were treated with panretinal photocoagulation (PRP) and 11 with RON. VA and fluorescein angiography were used to monitor the evolution of CRVO, and for follow-up. RESULTS All patients underwent PRP or RON with no major complications. The difference between pre- and post-operative VA was not statistically significant for either group (p=0.092 on PRP; p=.0081 on RON). The change in AVTT was also not statistically significant for either group (p= 0.024 on PRP; p=0.027 on RON). Ultimately, we found no statistically-significant difference in comparing VA and AVTT for the two groups (p =0.074 on VA; p=0.510 on AVTT). CONCLUSIONS No evidence supporting the effectiveness of RON could be found in this study, suggesting that surgical decompression by RON may not be effective for treating CRVO. Further studies regarding the efficacy of RON should be made.
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Affiliation(s)
- Tae Won Kim
- Department of Ophthalmology, College of Medicine, Kosin University, Busan, Korea
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Abstract
Radial optic neurotomy is a novel therapy for the treatment of ischemic central retinal vein occlusion. To date, the visual results are encouraging. Cutting in the optic nerve can cause visual field defects as shown in the presented case. This complication will reduce the value of this new surgical procedure and should be weighed against still unsettled advantages.
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Kaderli B, Avci R, Gelisken O. Radial optic neurotomy in central retinal vein occlusion: preliminary results. Int Ophthalmol 2005; 25:215-23. [PMID: 16200448 DOI: 10.1007/s10792-004-6267-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2004] [Accepted: 11/15/2004] [Indexed: 11/29/2022]
Abstract
BACKGROUND To investigate the efficacy of radial optic neurotomy (RON) on visual prognosis and clinical findings in central retinal vein occlusion (CRVO). METHODS Prospective, non-randomised, self-controlled comparative trial. Six patients with ischemic CRVO who had visual acuity (VA) less than or equal to 0.1 and duration of CRVO at least 1 month, and 6 patients with non-ischemic CRVO who maintained their VA less than or equal to 0.1 during the minimal follow-up of 3 months underwent pars plana vitrectomy and RON. LogMAR VA measurement and fluorescein angiography were performed before and after surgery. Automated perimetry was obtained from 4 patients at the last visit. Main outcome measures were VA and clinical changes in fundus appearance of CRVO evaluated with fundus photography and fluorescein angiography. RESULTS Radial optic neurotomy was successfully performed in all 12 patients without serious complications. All patients were of clinical improvement of fundus findings. In 11 (92%) patients, a visual improvement of at least 2 lines was observed. After mean follow-up of 9.3 months, mean improvement in VA was 5.1 +/- 3.1 lines (range, 2-14 lines). Cystoid macular oedema and degeneration were observed in 8 (67) patients. Four patients, two of whom had preoperative ocular hypertension had raised intraocular pressure controlled with topical antiglaucoma medication. In late postoperative period, one ischemic eye developed vitreous haemorrhage necessitating vitrectomy and endolaser photocoagulation. Automated perimetry revealed segmental visual field defects in all the examined eyes. CONCLUSIONS Radial optic neurotomy in CRVO yields clinical and visual improvement in majority of the patients. Cystoid macular oedema and degeneration are the major factors responsible for restriction of VA improvement. Further randomised and controlled studies with longer follow-up are essential to establish the appropriate timing and indications of RON in CRVO.
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Affiliation(s)
- Berkant Kaderli
- Department of Ophthalmology, Uludag University Faculty of Medicine, Gorukle, Bursa, Turkey
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Tsujikawa A, Fujihara M, Iwawaki T, Yamamoto K, Kurimoto Y. TRIAMCINOLONE ACETONIDE WITH VITRECTOMY FOR TREATMENT OF MACULAR EDEMA ASSOCIATED WITH BRANCH RETINAL VEIN OCCLUSION. Retina 2005; 25:861-7. [PMID: 16205565 DOI: 10.1097/00006982-200510000-00008] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To review the efficacy of a combination of triamcinolone acetonide (TA) injection and pars plana vitrectomy (PPV) for the treatment of macular edema associated with branch retinal vein occlusion (BRVO). METHODS Seventeen eyes with macular edema associated with BRVO underwent PPV with an intraoperative injection of TA (10 mg) into the vitreous cavity. Residual or recurrent macular edema was treated with postoperative sub-Tenon capsule injections of TA (20 mg). RESULTS With PPV and an intraoperative injection of TA, 82% of eyes showed rapid reduction of macular edema; foveal thickness decreased from 507 +/- 115 microm preoperatively to 261 +/- 123 microm 2 months after surgery (P = 0.0041). However, 59% of eyes showed recurrence of macular edema during the follow-up period. Twelve eyes with residual or recurrent macular edema received sub-Tenon capsule injections of TA; of these eyes, 9 showed substantial reduction of macular edema. Foveal thickness decreased from 381 +/- 102 microm to 256 +/- 56 microm (P = 0.0076) 2 weeks after postoperative injections of TA. At the final visit, visual acuity (logMAR) improved from 0.74 +/- 0.40 preoperatively to 0.40 +/- 0.34 (P = 0.010). CONCLUSION An intraoperative injection of TA in combination with PPV has the potential to facilitate the absorption of macular edema associated with BRVO. In addition, residual or recurrent macular edema can be treated with additional sub-Tenon capsule injections of TA.
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Affiliation(s)
- Akitaka Tsujikawa
- Department of Ophthalmology, Kobe City General Hospital, Kobe, Japan.
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Furino C, Ferrari TM, Boscia F, Cardascia N, Sborgia L, Reibaldi M, Ferreri P, Sborgia C. Combined Radial Optic Neurotomy, Internal Limiting Membrane Peeling, and Intravitreal Triamcinolone Acetonide for Central Retinal Vein Occlusion. Ophthalmic Surg Lasers Imaging Retina 2005. [DOI: 10.3928/1542-8877-20050901-14] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Schneider U, Inhoffen W, Grisanti S, Bartz-Schmidt KU. CHARACTERISTICS OF VISUAL FIELD DEFECTS BY SCANNING LASER OPHTHALMOSCOPE MICROPERIMETRY AFTER RADIAL OPTIC NEUROTOMY FOR CENTRAL RETINAL VEIN OCCLUSION. Retina 2005; 25:704-12. [PMID: 16141857 DOI: 10.1097/00006982-200509000-00004] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE To evaluate visual field defects after radial optic neurotomy (RON) for the treatment of central retinal vein occlusion (CRVO) by using scanning laser ophthalmoscope microperimetry. METHODS Thirteen eyes of 13 patients with severe vision loss (< or = 20/200) from CRVO who underwent pars plana vitrectomy and RON had postoperative Goldmann kinetic perimetry, scanning laser ophthalmoscope microperimetry, and fluorescein angiographic evaluation. RESULTS After a mean follow-up of 8 months, 6 of the 13 patients had visual improvement by > or = 2 lines. Eight patients developed an anastomosis at the radial cut. Postoperatively, sectorial visual field loss arising from the optic head was found by Goldmann perimetry in six patients, and a thin nerve fiber bundle defect was found in three patients. Four patients had no detectable visual field defect shown by Goldmann perimetry, but microperimetry demonstrated an absolute nerve fiber bundle defect arising from the radial cut at the optic disk for three of these patients. CONCLUSION Visual field loss after RON for the treatment of CRVO is a frequent complication. The etiology of this visual loss appears to be a combination of mechanical trauma to the nerve fiber layers and ischemia of the optic disk circulation.
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Affiliation(s)
- Ulrike Schneider
- Department I, University Eye Clinic Tuebingen, Tuebingen, Germany.
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Fang X, Sakaguchi H, Fujikado T, Osanai M, Ikuno Y, Kamei M, Ohji M, Yagi T, Tano Y. Electrophysiological and histological studies of chronically implanted intrapapillary microelectrodes in rabbit eyes. Graefes Arch Clin Exp Ophthalmol 2005; 244:364-75. [PMID: 16079995 DOI: 10.1007/s00417-005-0073-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2004] [Revised: 05/13/2005] [Accepted: 05/17/2005] [Indexed: 10/25/2022] Open
Abstract
PURPOSE To determine the safety and efficacy of transsclerally placed intrapapillary wire microelectrodes implanted chronically into the optic nerve head of rabbit eyes. METHODS Four platinum wire microelectrodes were passed through the sclera and implanted into the optic nerve head of five rabbit eyes for 4-6 months. Color fundus photography, fluorescein angiography, electroretinograms (ERGs), and visually evoked potentials (VEPs) were used to monitor the retina. Electrically evoked potentials (EEPs) were elicited by bipolar electrical stimulation of the optic nerve axons by different combinations of the four electrodes immediately after the implantation and at 1-month intervals thereafter. The effects of the chronic implantation of the electrodes on the morphology of the optic nerve were evaluated by histological and immunohistochemical examinations at 4 and 6 months after the implantation. RESULTS All of the electrodes remained stable in the implanted sites throughout the post-implantation period, except for one electrode that had pulled out of the optic nerve head at 1 month after implantation. No intraocular infection, inflammation, or vitreoretinal proliferation was observed in any eye. EEPs could be elicited from each pair of electrodes at all testing times. The mean threshold currents (charge densities) to evoke EEPs increased from 19.3 +/- 9.2 microA (6.0 +/- 2.9 microC/cm2) on the implantation day to 78.8 +/- 31.9 microA (24.6 +/- 10.0 microC/cm2) at 1 month after implantation, but did not change significantly thereafter. The implicit time and amplitude of the a- and b-waves of the ERGs and of P1 of the VEPs did not change significantly throughout the post-implantation period. Histological evaluation of the optic nerve head revealed slight tissue encapsulations surrounding the electrode and increased expression of glial fibrillary acidic protein near the surface of the optic nerve. CONCLUSIONS Implantation of transscleral intrapapillary microelectrodes appears to be safe and effective. These findings indicate that the implantation of microelectrodes in the optic nerve head should be considered for an optic nerve-based prosthesis.
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Affiliation(s)
- Xiaoyun Fang
- Department of Ophthalmology E-7, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan.
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Martínez-Jardón CS, Meza-de Regil A, Dalma-Weiszhausz J, Leizaola-Fernández C, Morales-Cantón V, Guerrero-Naranjo JL, Quiroz-Mercado H. Radial optic neurotomy for ischaemic central vein occlusion. Br J Ophthalmol 2005; 89:558-61. [PMID: 15834084 PMCID: PMC1772651 DOI: 10.1136/bjo.2004.048181] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND/AIMS Ischaemic central retinal vein occlusion (CRVO) accounts for 20-50% of all CRVO. No treatment has been proved to be effective. The efficacy of radial optic neurotomy (RON) was evaluated in eyes with ischaemic CRVO. METHODS 10 patients with ischaemic CRVO underwent RON. After pars plana vitrectomy, a microvitreoretinal blade was used to incise the scleral ring, cribriform plate, and adjacent sclera at the nasal edge of the optic disc. Best corrected visual acuity (BCVA), intraocular pressure (IOP), fluorescein angiography (FA), multifocal electroretinography (mfERG), and optical coherence tomography (OCT) were measured preoperatively and at 1, 3, and 6 months postoperatively. RESULTS No visual improvement was noted in the eyes that underwent RON. FA and mfERG showed no increase in retinal perfusion or retinal function postoperatively. Mean macular central thickness changed from 841 (SD 170) mum preoperatively to 162 (SD 34) microm at the sixth postoperative month. One patient had retinal central artery perforation intraoperatively. One patient developed neovascular glaucoma. CONCLUSION RON in ischaemic CRVO did not improve visual function (by mfERG) or visual acuity although macular thickness did improve. This technique may be associated with potential risks. Randomised studies are needed to corroborate these results.
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Affiliation(s)
- C S Martínez-Jardón
- Retina Service, Hospital Dr Luis Sanchez Bulnes, Asociación Para Evitar la Ceguera en México, Vicente García Torres No 46, San Lucas Coyoacan 04030, México City, México
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Williamson TH, O'Donnell A. Intravitreal triamcinolone acetonide for cystoid macular edema in nonischemic central retinal vein occlusion. Am J Ophthalmol 2005; 139:860-6. [PMID: 15860292 DOI: 10.1016/j.ajo.2005.01.001] [Citation(s) in RCA: 79] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/03/2005] [Indexed: 11/24/2022]
Abstract
PURPOSE The effectiveness of intravitreal triamcinolone acetonide in the treatment of cystoid macular edema from central retinal vein occlusion (CRVO) was investigated. DESIGN A noncomparative, prospective, interventional case series. METHODS In a clinical practice, 18 patients were enrolled with nonischemic CRVO and cystoid macular edema. Two milligrams of triamcinolone acetonide were injected into the vitreous of only one eye from each patient. The outcome measures were 1-mm mean central retinal thickness on optical coherence tomography and visual acuity. RESULTS Mean duration of symptoms before surgery was 2 months (SD, 1.3 months). Ten patients required repeated injections for recurrent cystoid macular edema (mean, 1.8 injections). Mean visual acuity significantly improved from 20/300 to 20/166 (P = .007) at 1 month, 20/100 (P = .0005) at 2 months, 20/130 (P = .007) at 3 months, and 20/150 (P = .02) at 6 months but deteriorated again to 20/270 (not significant) at 12 months. There was a significant improvement in retinal thickness from presentation 518 microm, to 363 microm (P = .03) at 1 month, 304 microm (P = .04) at 2 months, and 353 microm (P = .01) at 3 months but not from presentation at 6 months (mean, 383 microm) and 12 months (mean, 406 microm). Eleven patients suffered intraocular pressure rises requiring intervention. Intravitreal triamcinolone acetonide did not prevent collateral circulation formation, which was seen in 10 patients. CONCLUSION Intravitreal corticosteroid injection is very effective in reversing cystoid macular edema and improving visual acuity in recent-onset nonischemic CRVO in the first 6 months, but this is unfortunately not sustained at 1 year.
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Affiliation(s)
- Tom H Williamson
- Department of Ophthalmology, St Thomas' Hospital, Lambeth Palace Road, London SE1 7EH, United Kingdom.
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Mirshahi A, Roohipoor R, Lashay A, Mohammadi SF, Mansouri MR. Surgical induction of chorioretinal venous anastomosis in ischaemic central retinal vein occlusion: a non-randomised controlled clinical trial. Br J Ophthalmol 2005; 89:64-9. [PMID: 15615749 PMCID: PMC1772461 DOI: 10.1136/bjo.2004.045278] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
AIM To evaluate the safety and efficacy of surgical induction of chorioretinal venous anastomosis in the management of ischaemic central retinal vein occlusion (CRVO). METHODS In a comparative clinical trial, 28 patients with ischaemic CRVO were included, of whom 18 who declined surgery were considered as controls. The 10 surgical cases underwent standard vitrectomy with incisions into the choroids adjacent to the partially cut major retinal veins. Mersilene suture insertion was done to induce chorioretinal venous shunt. Mild endolaser was applied. Patients were followed up for 6-18 (mean 10) months. RESULTS Clinical success in shunt development was 90%. Surgical cases had a significantly better visual acuity improvement compared with controls (mean difference: 1.5 logMAR, p = 0.001) with 80% of them showing improvement (compared with 28% of the controls, p = 0.016). Neovascularisation developed in 39% of the control group compared with 0% of the surgical cases (p = 0.03). In multivariate analysis, surgery remained the sole significant predictor of visual improvement. There were three re-operations for vitreous cavity haemorrhage, cataract, and retinal detachment. CONCLUSIONS Surgical induction of chorioretinal venous anastomosis may result in visual acuity improvement and prevent neovascularisation in ischaemic CRVO. Randomised studies are needed to compare the current study modality with the natural course of CRVO and emerging procedures, such as optic neurotomy, in the management of ischaemic CRVO.
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Affiliation(s)
- A Mirshahi
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, PO Box 14155-7146, Tehran, Iran
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Beck AP, Ryan EA, Lou PL, Kroll AJ. Controversies regarding radial optic neurotomy for central retinal vein occlusion. Int Ophthalmol Clin 2005; 45:153-61. [PMID: 16199974 DOI: 10.1097/01.iio.0000177429.82022.c3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Affiliation(s)
- Adam P Beck
- Massachusetts Eye and Ear Infirmary, Harvard Medical School, 243 Charles Street, Boston, MA 02114, USA
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Yamamoto S, Takatsuna Y, Sato E, Mizunoya S. Central retinal artery occlusion after radial optic neurotomy in a patient with central retinal vein occlusion. Am J Ophthalmol 2005; 139:206-7. [PMID: 15652858 DOI: 10.1016/j.ajo.2004.07.031] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/13/2004] [Indexed: 11/25/2022]
Abstract
PURPOSE To describe a patient with a central retinal vein occlusion (CRVO) who developed central retinal artery occlusion after radial optic neurotomy. DESIGN Interventional case report. METHODS A 70-year-old woman with CRVO underwent a radial optic neurotomy on her right eye. Her preoperative visual acuity in the affected eye was 20/400. RESULTS Radial optic neurotomy was performed after phacoemulsification and aspiration for a cataract with intraocular lens implantation. At the insertion of a CRVO knife, pulsating bleeding occurred from the cup of the optic disk; the bleeding was stopped within 2 minutes by elevating the intraocular pressure to 80 mm Hg. On the following day, the patient noticed that she had lost light perception. Fluorescein angiography showed a marked delay of arterial filling, indicating a central retinal artery occlusion. Retinal circulation returned to normal 2 months later; however, her vision was still no light perception. CONCLUSIONS Ophthalmologists should be aware that severe complications such as central retinal artery occlusion can be associated with radial optic neurotomy, which is an unproven surgical procedure with a questionable pathophysiologic mechanism.
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Affiliation(s)
- Shuichi Yamamoto
- Department of Ophthalmology and Visual Science, Chiba University Graduate School of Medicine, Chiba, Japan.
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Abstract
Central retinal vein occlusion is a common retinal disease with usually severe complications. At present no safe treatment exists promoting the recovery of lost vision. Several surgical approaches to modify the natural course of the disease have been proposed in recent years. These options include laser-induced chorioretinal venous anastomosis, the injection of tissue plasminogen activator into a retinal vein, optic nerve decompression, and vitrectomy for macular edema. Even though all the proposed treatments have not yet been supported by randomized clinical trials, these techniques can be considered as innovative in an area where no effective treatment is available. Larger clinical trials are required to assess both the effectiveness and complication rate of surgical treatments designed to reverse the natural evolution of central retinal vein occlusion.
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Zambarakji HJ, Ghazi-Nouri S, Schadt M, Bunce C, Hykin PG, Charteris DG. Vitrectomy and radial optic neurotomy for central retinal vein occlusion: effects on visual acuity and macular anatomy. Graefes Arch Clin Exp Ophthalmol 2004; 243:397-405. [PMID: 15931541 DOI: 10.1007/s00417-004-1046-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2004] [Revised: 07/31/2004] [Accepted: 09/09/2004] [Indexed: 10/26/2022] Open
Abstract
BACKGROUND Central retinal vein occlusion (CRVO) is a common retinal vascular disorder and a leading cause of visual loss. It is thought to arise from vascular obstruction at the level of the lamina cribrosa. The purpose of the study reported here was to evaluate the potential benefit of radial optic neurotomy (RON) and determine its effect on foveal thickness and macular volume in patients with CRVO. METHODS We conducted a prospective pilot study of ten patients with CRVO. Visual acuity (VA) score measured with the Early Treatment Diabetic Retinopathy Study chart and the corresponding Snellen equivalent were assessed before and 6 months after surgery. Colour fundus photography, fluorescein angiography (FA) and optical coherence tomography (OCT) were carried out before and at 2, 6, 12 and 24 weeks after surgery. Foveal thickness and macular volumes were assessed using OCT. RESULTS Visible reperfusion was observed in four of the ten patients at the time of surgery. VA score improved in eight of the ten patients from a median score of 11.50 (range 0-68) to a median score of 35.00 (range 3-79). Macular volumes decreased in six of seven patients from a median of 4.99 mm3 (range 2.68-6.77) to a median of 3.11 mm3 (range 1.11-5.02). Foveal thickness decreased in six of seven patients from a median of 596.50 microm (range 338.50-745.50) to a median of 330.50 microm (range 118-634.50). Six of ten patients developed a chorioretinal venous anastomosis. Macular oedema on OCT persisted in six of ten patients. CONCLUSIONS We observed an improvement in VA score and a corresponding reduction in foveal thickness and macular volume following RON, but macular oedema persisted in 60% of patients. Whilst optimisation of patient selection criteria remains a challenge, this pilot study suggests that RON has a beneficial effect on VA in patients presenting with CRVO.
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Poulson AV, Snead DRJ, Jacobs PM, Ahmad N, Snead MP. Intraocular surgery for optic nerve disorders. Eye (Lond) 2004; 18:1056-65. [PMID: 15534590 DOI: 10.1038/sj.eye.6701572] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
This article discusses two current indications for intraocular surgery for optic nerve conditions. The first topic is macular detachment in association with congenital optic disc pit, and includes a review of the theories of pathogenesis and management options including our own experience of treatment with vitrectomy and gas tamponade. In addition, the histopathological findings of a new case of optic disc pit with serous macular detachment are presented, adding to the rare examples previously reported. The second subject is a radial optic neurotomy, a recently advocated treatment for central retinal vein occlusion, which, despite its controversial nature, is gaining in popularity.
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Affiliation(s)
- A V Poulson
- Vitreoretinal Service, Addenbrooke's NHS Trust, Cambridge, UK.
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Evaluation of radial optic neurotomy for central retinal vein occlusion by indocyanine green videoangiography and image analysis. Am J Ophthalmol 2004; 138:612-9. [PMID: 15488789 DOI: 10.1016/j.ajo.2004.06.012] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/03/2004] [Indexed: 11/21/2022]
Abstract
PURPOSE To evaluate the effects of radial optic neurotomy (RON) on retinal circulation in patients with central retinal vein occlusion (CRVO) by indocyanine green (ICG) videoangiography and a computer-assisted image analysis. DESIGN An interventional case series. METHODS RON was performed in 15 eyes of 15 patients with CRVO. Within 72 hours before the surgery and at 3 months after the surgery, ICG videoangiography was performed with a scanning laser ophthalmoscope, and the images were transferred to a computer. Two measurement points were selected, one on a main retinal artery close to the optic disk and the other on the corresponding retinal vein. At each point, fluorescence intensities were serially measured, and dye dilution curves were obtained. Retinal circulation times (DeltaT(50)) before and after the surgery were calculated. RESULTS Mean preoperative DeltaT(50) was 6.46 +/- 1.36 seconds, and mean postoperative DeltaT(50) was 6.80 +/- 2.50 seconds. In 8 of 15 eyes, T(50) decreased by 6.8% to 29.6% after the surgery. In the seven eyes that developed chorioretinal anastomosis (CRA) at the site of RON, DeltaT(50) decreased after the surgery. In contrast, DeltaT(50) decreased postoperatively in only one of the eight eyes without CRA. Best-corrected visual acuity improved significantly after the surgery in the group of eyes with improvement in DeltaT(50), but not in the group of eyes without improvement in DeltaT(50). CONCLUSIONS Some degree of retinal circulation improvement occurred in approximately half of these eyes, which appears to be correlated with the development of CRA.
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