Vitrectomy with arteriotomy and neurotomy in retinal artery occlusion – A case series

Purpose: This study aimed to investigate the visual outcomes and anatomical changes after vitrectomy for retinal artery occlusion. Methods: Twelve patients with retinal artery occlusion (11 central retinal artery occlusion and 1 branch retinal artery occlusion) were part of this study. Our patients were treated with vitrectomy with arteriotomy or with neurotomy and arteriotomy. Complete ophthalmic examination was performed preoperatively, at 2 weeks, and 1, 3, 6, 9, and 12 months after surgery. Results: The mean preoperative best?corrected visual acuity (BCVA) was 1.94 logMAR, and the final BCVA after 12?months follow?up was 2.04 logMAR. After vitrectomy with arteriotomy, the BCVA in patients treated with neurotomy and arteriotomy was 1.65 and 2.45, respectively (P = 0.038). Conclusion: No benefits have been achieved from using vitrectomy in retinal artery occlusion cases

Where will the surgical treatment of central retinal vein occlusion go? / 眼科

There are many research reports about surgical treatments for central retinal vein occlusion (CRVO) up to date, such as radial optic neurotomy, vitrectomy combined with internal limiting membrane removal or not, t-PA retinal venous thrombelysis, oph-thalmic artery thrombolysis and so on. However, the most of the therapeutic methods are controversial, the action mechanism of some therapies are still not clear, and their complications should be taken attendtion seriously. So in the future it is necessary to conduct multiple centre prospective randomized controlled trials for evaluating the role of different surgical therapies for CRVO. (Ophthalmol CHN, 2009, 18: 217-220)

Retinal Choroidal Collateral Circulation After Radial Optic Neurotomy for Central Retinal Vein Occlusion

PURPOSE: To evaluate the incidence of retinal choroidal collateral circulation after radial optic neurotomy (RON) with central retinal vein occlusion (CRVO) patients and to correlate these collaterals with changes in visual acuity. METHODS: We conducted a retrospective study of 17 eyes of 17 consecutive patients diagnosed with CRVO who underwent RON after a standard three port-vitrectomy. Fundus examination and, FAG were performed to evaluate the incidence of retinal choroidal collateral circulation according to preoperative best corrected visual acuity. We evaluated changes in best corrected visual acuity according to chorioretinal circulation formation. RESULTS: Retinochoroidal shunts developed in 9 eyes (52.9%) at the site of radial optic neurotomy. The group whose initial visual acuity was better than 0.02 (72.7%) developed more shunts than the group whose initial visual acuity was under 0.02 (16.7%) (P=0.043). Changes in visual acuity were highly correlated with the development of collaterals from the retinal to choroidal circulation (P=0.008). CONCLUSIONS: Patients whose that initial visual acuity is better than 0.02 have more retinal choroidal collaterals. Surgical induction of retinochoroidal venous anastomosis may result in visual acuity improvement. Randomized studies are needed to compare the current study modality with the natural course of central retinal vein occlusion.

Long-term Study of Radial Optic Neurotomy in Central Retinal Vein Occlusion

PURPOSE: To determine the clinical effect of radial optic neurotomy (RON) in central retinal vein occlusion (CRVO). METHODS: The retinal findings, visual acuity and complications were analyzed in patients who had undergone RON for the treatment of CRVO and were followed up 10 months or more after surgery. RESULTS: Of all 16 patients (16 eyes), the mean age was 55 years and the follow-up period was 14 months. Preoperative anterior segment and retinal neovascularization was observed in each three eyes. All eyes showed improvement in the retinal findings within two weeks after RON. The postoperative complications included vitreous hemorrhage in 1 eye, chorioretinal collateral circulation in 1 eye, neovascular glaucoma in 1 eye, vitreous hemorrhage and neovascular glaucoma in 1 eye. The visual acuity was counting fingers or less in 8 eyes preoperatively and in 2 eyes finally, and was less than 0.1 in 13 eyes preoperatively and in 10 eyes finally. The mean visual improvement in the 3.8 lines was in 11 eyes and a loss of 2.5 lines in 2 eyes. The maximum velocity of the blood flow of CRV improved with 1.95 +/- 0.93 cm/sec on the average in the 7 eyes examined by color doppler. CONCLUSIONS: RON appears to be safe and effective for improving the retinal findings, visual acuity and blood flow of CRV in CRVO. However, the visual recovery is limited.

Comparative Evaluation of Radial Optic Neurotomy and Panretinal Photocoagulation in the Management of Central Retinal Vein Occlusion

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.

The Efficacy of Radial Optic Neurotomy for Central Retinal Vein Occlusion

PURPOSE: Central retinal vein occlusion (CRVO) often produces significant and permanent loss of vision in the affected eye, however there is no known effective treatment of CRVO. By restoration of retinal venous circulation via radial optic neurotomy (RON), we want to know the efficacy and complication of radial optic neurotomy were evaluated. METHODS: Ten eyes of 10 consecutive patients diagnosed as CRVO in Chonbuk national university hospital with best visual acuity 0.1 or worse underwent RON after a standard three-port vitrectomy as Opremcak's study. The average duration of the CRVO prior to RON was 2.4 months with a range of 1-9 months. RESULTS: The average follow-up was 5 months with a range of 1-12 months. Equal or better postoperative visual acuity, rapid resolution of intraretinal hemorrhage and restoration of normal retinal vasculature were noted in 8 of the 10 (80%) patients. 5 of the 10 (50%) patients had a final visual acuity of 0.1 or better. two patients achieved 0.3 final visual acuity, one patient achieved 0.6 final visual acuity. CONCLUSIONS: Compared with others without any treatment, RON may be a beneficial surgical procedure for severe CRVO and 0.1 or worse visual acuity. More cases and longer follow-up are needed to establish the indication, efficacy, and safety of RON in CRVO

Follow up Results after Radial Optic Neurotomy for Central Retinal Vein Occlusion

PURPOSE: We evaluated the safety and efficacy of radial optic neurotomy (RON) in eyes with central retinal vein occlusion (CRVO). METHODS: We performed standard tri-port pars plana vitrectomy and RON in 7 eyes (7 patients) which were diagnosed with CRVO at Konyang University Hospital from December 2001 to November 2002. The eyes had best corrected visual acuities of less than 20/200 and revealed macular edema and hemorrhage on optical coherence tomography and fluorescein angiography. Visual acuity, fundus examination, fundus photography, optical coherence tomography, and fluorescein angiography were performed both preoperatively and postoperatively in all cases. Visual fields were performed preoperatively and postoperatively in 2 eyes. RESULTS: No intraoperative complications occurred in any case except bleeding from incision sites, but we noted defects corresponding to the incision sites of RON on visual field tests in 2 eyes. In 6 of the 7 eyes, the findings improved on fundus photography, optical coherence tomography, and fluorescein angiography. In 2 of the 6 eyes, the visual acuities improved to better than 20/30, but the other 4 eyes showed no improvement. CONCLUSIONS: The surgical decompression of CRVO via RON was a relatively safe procedure, and demonstrated the benefit of rapid reperfusion of retina. However, further studies are needed to establish the safety and long term efficacy of the surgery.