Long-term Visual Outcome of Arteriovenous Adventitial Sheathotomy on Branch Retinal Vein Occlusion Induced Macular Edema

PURPOSE: To evaluate long-term visual outcome of arteriovenous adventitial sheathotomy in BRVO-induced macular edema. METHODS: The visual outcomes of 8 patients following vitrectomy with arteriovenous adventitial sheathotomy for BVO-induced macular edema (surgery group) were retrospectively evaluated. The three-year post-operative visual acuity of the surgery group was compared with that of the conservatively managed controls. RESULTS: All patients were followed for a minimum of 36 months. Mean BCVA (logMAR) in the surgery group changed from 1.10+/-0.34 to 1.19+/-0.70 and to 0.80+/-0.36 at 12 and 36 months, respectively (p=0.959 at 12 months, p=0.018 at 36 months). In the control group, visual acuity improved from 1.15+/-0.43 to 0.43+/-0.44 and to 0.43+/-0.39 at 12 and 36 months, respectively (p=0.015 at 12 months, at p=0.003 at 36 months). A strong trend toward better visual acuity at 12 months and final examination was observed for controls. (surgery vs. control group, p=0.052 at 12 months, p=0.066 at 36 months). CONCLUSIONS: Considering the favorable natural course of BVO and the unproven effect of reperfusion on macular edema, surgical efficacy of arteriovenous adventitial sheathotomy requires further evaluation.

Arteriovenous Sheathotomy for Persistent Macular Edema in Branch Retinal Vein Occlusion

PURPOSE: To evaluate the efficacy of arteriovenous (AV) sheathotomy with internal limiting membrane peeling for persistent or recurrent macular edema after intravitreal triamcinolone injection and/or laser photocoagulation in branch retinal vein occlusion. METHODS: Twenty-two eyes with branch retinal vein occlusion (BRVO) with recurrent macular edema underwent vitrectomy with AV sheathotomy and internal limiting membrane peeling. All eyes had previous intravitreal triamcinolone injection and/or laser photocoagulation for macular edema. The best corrected visual acuity (BCVA), fluorescein angiography and optical coherence tomography (OCT) before and after surgery were compared. RESULTS: The mean preoperative BCVA (log MAR) were 0.79+/-0.29 and postoperative BCVA (log MAR) at 3 months was 0.57+/-0.33. And improvement of visual acuity > or =2 lines was observed in 10 eyes (45%). The mean preoperative fovea thickness measured by OCT was 595.22+/-76.83 micrometer (510-737 micrometer) and postoperative fovea thickness was 217.60+/-47.33 micrometer (164-285 micrometer). CONCLUSIONS: Vitrectomy with AV sheathotomy can be one treatment option for the patients with recurrent macular edema in BRVO.

The Effect of Vitrectomy and Arteriovenous Adventitial Sheathotomy for Branch Retinal Vein Occlusion

PURPOSE: We evaluated the effect of vitrectomy and arteriovenous adventitial sheathotomy for branch retinal vein occlusion (BRVO) according to operation timing and obstruction site. METHODS: We performed vitrectomy and arteriovenous adventitial sheathotomy in 14 eyes with BRVO. Patient selection criteria were foveal involvement of macular hemorrhage or macular edema and a best corrected visual acuity (BCVA) of 0.1 or less. We compared 7 eyes with symptom duration of 2 months or less (Group 1) and 7 eyes with symptom duration of more than 2 months (Group 2). We analyzed 7 eyes for which the obstruction site was 1 disc diameter (DD) or less from the disc margin (Group A) and 7 eyes of more than 1 DD (Group B). RESULTS: Seven of 14 eyes (50%) had visual improvement. Six eyes of Group 1 (86%) had visual improvement and Group 1 had better visual improvement than Group 2. There was a statistically significant difference between Groups 1 and 2 (p=0.029). Five eyes of Group A (71%) had visual improvement and Group A had better visual improvement than Group B. There was no statistically significant difference (p=0.286). CONCLUSIONS: In the case of foveal involvement of macular hemorrhage or macular edema and a BCVA of 0.1 or less, vitrectomy and arteriovenous adventitial sheathotomy are effective in early BRVO.

Arteriovenous Adventitial Sheathotomy for the Treatment of Macular Edema Associated with Branch Retinal Vein Occlusion

PURPOSE: To report the arteriovenous (AV) adventitial sheathotomy for the treatment of macular edema associated with branch retinal vein occlusion (BRVO). METHODS: Seven eyes of seven patients with best corrected visual acuity of less than 20/200 secondary to BRVO received pars plana vitrectomy and AV adventitial sheathotomy, and were followed postoperatively for 1, 2, and 4 months. RESULTS: Intraoperative decompression of the AV crossing was achieved in all 7 patients. All patients showed clinical improvement as determined by fundus examination, optical coherent tomography, and fluorescein angiography. Postoperative visual acuity was better in 6 of the 7 patients (86%) with an average of two lines of vision being gained. CONCLUSIONS: AV adventitial sheathotomy may be beneficial for selected patients with poor vision secondary to BRVO.

Five Cases of Arteriovenous Adventitial Sheathotomy for Branch Retinal Vein Occlusion

PURPOSE: To report the results of arteriovenous adventitial sheathotomy for treatment of macular edema associated with branch retinal vein occlusion. METHODS: Five eyes of five patients underwent arteriovenous adventitial sheathotomy. Patient selection criteria were the best-corrected visual acuity of less than 0.1 and duration of less than 1 month. Pars plana vitrectomy was performed and 23 gauge needle, bent at the tip, was used to cut through the adventitial sheath and separate the arteriole from the underlying venule. Patients were followed postoperatively for 6 months to 1 year, with an average of 9.6 months. RESULTS: In all 5 patients, the best-corrected visual acuity improved to 0.3 to 0.9. Fluorescein angiography demonstrated reperfusion of the retina and lessening of macular edema. CONCLUSION: Arterionvenous adventitial sheathotomy may be beneficial for patients with poor vision secondary to branch retinal vein occlusion.