Radial optic neurotomy (RON) in central retinal vein occlusion (CRVO)--preliminary report

PURPOSE: Practical application of radial optic neurotomy for patients with central retinal vein occlusion, based on our initial experience. MATERIAL AND METHODS: Three patients with central retinal vein occlusion underwent pars plana vitrectomy with radial optic neurotomy at the nasal site of the optic disc. RESULTS: Improvement of visual acuity by one or three lines in two of three patients who underwent RON. Partial clearing of retinal haemorrhages and retinal oedema occurred in all cases. No serious complications developed intra- and postoperatively. CONCLUSIONS: Radial optic neurotomy remains a controversial but also promising treatment for eyes with CRVO. Further study is necessary to establish RON as a standard therapy for CRVO.     

放射状视神经切开术治疗视网膜中央静脉 阻塞的初步观察

目的观察放射状视神经切开术（RON）治疗视网膜中央静脉阻塞（CRVO）的临床效果。方法回顾分析 5例经平坦部玻璃体途径行RON治疗的CRVO患者的临床资料。其中，2例患者手术前确诊为CRVO，手术前后分别进行视力、眼底照相、荧光素眼底血管造影（FFA）、彩色超声多谱勒（CDI）血流扫描、电脑视野及光相干断层扫描（OCT）等检查；3例患者因玻璃体积血接受手术治疗，手术中确诊为CRVO所致。5例均有明显黄斑水肿。对比观察患者手术前后视力、眼底检查及手术后眼底照相和OCT检查结果。手术后随访12个月。结果除1例患者视力下降外，其余4例患者视力均有不同程度提高。 眼底照相和（或）FFA、OCT检查显示手术后1个月时黄斑水肿均明显消退，手术后2个月时眼底出血基本吸收， 1例行视野检查者显示手术后视野改善。1例手术后出现玻璃体积血，2例手术中穿刺视盘时出血。结论RON可有助于CRVO患者改善患眼黄斑水肿，减少眼底出血，防止新生血管形成，并能一定程度地提高视力，对治疗CRVO具有一定可行性及临床价值。但尚需要较大规模、多中心的随机临床对照观察来进一步研究证实。(中华眼底病杂志,2005,21:6-9)     

放射状视神经切开术治疗视网膜中央静脉阻塞

目的观察放射状视神经切开术（RON）治疗视网膜中央静脉阻塞（CRVO）的临床疗效。方法回顾分析12例CRVO患者RON治疗的临床资料。所有患者均进行常规视力和眼底检查、眼底照相和荧光素眼底血管造影（FFA）、光相干断层扫描（OCT）检查。12只患眼视力均在0.1以下，伴有严重出血、视网膜水肿。手术时用显微玻璃体视网膜刀（MVR）或CRVO切开刀（CRVO knife）刺入视盘鼻侧，切口深达筛板及筛板后且于筛板区鼻侧切开。手术后随访观察2~15个月，平均随访时间为6.5个月。对比观察手术眼视力、视野及眼底改变情况。结果12只患眼的RON手术均获成功。9只眼视力有不同程度提高，占75%，6只眼手术后视力大于或等于0.1，占50%。眼底检查、眼底照相和FFA、OCT检查显示视网膜水肿、出血逐渐消失，静脉怒张、纡曲明显好转；视网膜浆液性脱离减轻或消失；黄斑囊样水肿消退，3只眼黄斑中心凹恢复。3只眼手术中视神经出血，晚期4只眼视神经切开部位萎缩。结论视盘鼻侧边缘的RON安全可行，可以改善CRVO患眼的视力，缓解视网膜出血和水肿。(中华眼底病杂志,2005,21:10-12)     

放射状视神经切开术治疗视网膜中央静脉阻塞的效果观察

目的观察放射状视神经切开术(RON)治疗视网膜中央静脉阻塞(CRVO))的效果。方法CRVO患者7例(7眼),均进行眼科常规检查、眼底荧光血管造影(FFA)和光学相干断层扫描(OCT)检查后确诊。行标准三通道闭合式玻璃体切除手术后,使用改良的MVR刀在视盘鼻侧缘做放射状视神经切开术。结果术中和术后无严重并发症。6例术后视网膜出血、静脉迂曲扩张和黄斑水肿等视网膜淤滞状态逐渐消退,视力均有不同程度的提高。1例年轻患者术后发生玻璃体积血。结论RON手术可以改善CRVO的视网膜淤滞状态和提高视力,但需要进一步观察手术的远期效果。     

Radial optic neurotomy for ischemic central retinal vein occlusion

INTRODUCTION: Occlusion of the central retinal vein (CRVO) is the second most frequent cause for blindness in the course of pathological changes of the vascular system. Vitreous haemorrhages and neovascular glaucoma are known as serious complications. Clinically accepted guidelines for treating CRVO do not exist up to now. In this report our results after radial optic neurotomy (RON) of patients suffering from CRVO associated with visual deterioration are summarised. PATIENTS AND METHOD: 78 patients (mean age 68 year, gender: 41 male, 37 female) with visual acuity of 0.2 or worse were treated with RON. Mean follow-up was 13 months. 35 patients underwent previously haemodilution treatment without success. Visual acuity tests, fluorescein angiographic appearance, OCT and postoperative complications were analysed, in 47 % additionally VEP, ERG and the visual field were evaluated. RON was carried out by conventional pars plana vitrectomy. Neurotomy was performed at the nasal side of the optic disc in all cases. Neither ILM peeling nor gas tamponade was used. Follow-up examinations were carried out after 2 and 4 weeks, after 3 and 6 months and after 3 years. RESULTS: Improvement of morphological parameters could be registered in 95 % of our patients by means of fluorescein angiography or OCT. Visual acuity improved in 81 % and worsened in 10 %. After 6 months patients with non-ischaemic CRVO had a significantly better visual acuity compared to patients with ischaemic CRVO. A retino-choroidal anastomosis could be observed in 38 (48 %) eyes, all these patients experienced visual improvement. The results of VEP and ERG showed partial recovery in all cases. A temporal visual field defect occurred postoperatively in 95 % of our patients. CONCLUSION: Visual acuity of patients suffering from non-ischaemic CRVO with low preoperative visual acuity and short history may improve after RON. Frequent complications were temporal field defects and vitreous haemorrhage. Further randomised studies are necessary to compare these results after RON with other alternative therapeutic procedures, for example, intravitreal injection of VEGF inhibitors.     

Radial optic neurotomy as treatment for central retinal vein occlusion

PURPOSE: To review our initial experience with radial optic neurotomy as treatment for retinal vein occlusion. DESIGN: Interventional case series. METHODS: Patient population: five patients (four with central retinal vein occlusion and one with hemiretinal vein occlusion). INTERVENTION: Pars plana vitrectomy with radial optic neurotomy was performed in each case. MAIN OUTCOME MEASURES: Best-corrected visual acuity, presence of macular edema, perfusion status, and time to venous phase of the angiogram were reviewed retrospectively. RESULTS: Mean preoperative visual acuity was 4/200. Preoperatively, the vein occlusion was perfused in one (20%), nonperfused in one (20%), and indeterminate in three (60%). Mean follow-up time was 4.5 months. Mean postoperative visual acuity was 20/400 at last follow-up. Four patients (80%) had improvement in visual acuity and one (20%) worsened. Two patients (40%) improved to 20/80 postoperatively. In four cases (80%), disk congestion improved and intraretinal hemorrhage reabsorbed more quickly than would be expected without treatment. Time to the venous phase of fluorescein angiography improved slightly in three cases (60%) postoperatively. Perfusion status as determined by fluorescein angiography was not significantly altered postoperatively. One patient (20%) had resolution of macular edema postoperatively as shown by volumetric optical coherence tomography. One patient developed choroidovitreal neovascularization and one developed iris neovascularization postoperatively, both of which responded to panretinal photocoagulation. CONCLUSIONS: Radial optic neurotomy may improve visual acuity in eyes with central retinal vein occlusion, although choroidovitreal neovascularization from the neurotomy site can occur. Further study is needed to determine its role in the management of central vein occlusion.     

Radial optic neurotomy in ischemic central retinal vein occlusion

BACKGROUND: Loss of visual acuity due to ischemic retinal vein occlusion (RVO) is still a major problem in ophthalmology. Prognosis is poor and loss of vision is a severe risk. New approaches for treatment like systemic fibrinolysis and surgical procedures have been suggested. PATIENTS AND METHODS: In a clinical trial 8 patients with ischemic CRVO underwent surgical decompression. Strict criteria of inclusion were maintained. Radial optic neurotomy (RON) was performed 0.25-5 months after retinal vein occlusion. Follow up-time was 3 months. Visual acuity and incidence of typical complications after RVO were the main points of interest in our scientific evaluation. RESULTS: Visual acuity improved significantly after the surgical procedure. For ischemic CRVO EDTRS charts increased from logMAR 1.0 (decimal 0.17) to 0.68 (0.30) at 3 months after surgery. Surgical or early complications did not occur within 3 months. The recovery of retinal blood flow during fluorescein angiography was investigated in 75 % of the patients. A resolution of non perfusion-areas could be detected in 50 % of the eyes. CONCLUSIONS: For patients with retinal vein occlusion RON seems to be a safe and feasible procedure. The results indicate the potential to improve visual acuity while typical complications due to surgery or vein occlusion did not occur during the first three months.     

放射状视神经切开治疗视网膜中央静脉阻塞

视网膜中央静脉阻塞是常见的致盲性眼病。目前许多治疗措施主要是针对黄斑水肿或新生血管性青光眼等并发症,方法包括药物、激光和手术。我们针对放射状视神经切开术做简单综述。     

视乳头切开术治疗视网膜中央静脉阻塞12例报告

目的:探讨视乳头切开术治疗缺血性视网膜中央静脉阻塞的临床疗效.方法:缺血性视网膜中央静脉阻塞患者12例.术前患者均行眼底照相、荧光素眼底血管造影(FFA)检查.手术常规做玻璃体切割,应用显微玻璃体视网膜切开刀,以鼻侧视乳头边缘为中心,垂直刺入达最宽处为止.术后1,3,6mo行眼底照像、FFA检查.结果:术中,视乳头切开后均可见视盘近端视网膜静脉充盈增加,9例术中穿刺时有少量出血,未经特殊处理均很快停止,1例术中发生局限性视网膜下出血.术后1mo内,11例患者视网膜或黄斑水肿均减轻或消退.术后3mo,患者行眼底照像、FFA检查结果均显示视网膜出血吸收,黄斑水肿消退;10例视力较术前提高(80%).1例保持不变,1例术中发生局限性视网膜下出血者术后视力下降.结论:视乳头切开术是安全有效的手术,有助于视网膜内出血、渗出及黄斑水肿的消退,部分患者视力可得到改善.     

Radial optic neurotomy for ischaemic central vein occlusion

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.     

放射状视神经切开术治疗缺血型视网膜中央静脉阻塞伴黄斑水肿的疗效评估

目的评估放射状视神经切开术（RON）治疗缺血型视网膜中央静脉阻塞（CRVO）伴黄斑水肿的效果。方法回顾性分析2005～2007年行RON治疗的18例缺血型CRVO伴明显黄斑水肿患者的临床资料,其中15例术前确诊为缺血型CRVO,3例玻璃体积血手术后确诊为缺血型CRVO。手术前后均进行视力、荧光素眼底血管造影（FFA）、光相干断层扫描（OCT）检查。术后随访1周,1、3、6个月,比较患者手术前后的检查结果。所有患者在应用药物或手术前均签署知情同意书。结果除3例病程太长或黄斑变性视力未恢复,其余15例视力在短期内均有不同程度的提高,视力恢复〈3个月组好于〉3个月组（p=0．025）。眼底照相、OCT及FFA检查结果显示黄斑水肿均在1个月内明显消退,眼底出血3个月内吸收。1例术中穿刺视盘时出现鼻侧视网膜下局限性出血。结论RON能够改善缺血型CRVO合并的黄斑水肿。早期手术干预视力预后较好。术中联合应用的黄斑内界膜剥离术所起的作用尚需进一步评估。     

Radial optic neurotomy for severe central retinal vein occlusion: preliminary results

PURPOSE: To describe the results of radial optic neurotomy for the treatment of severe central retinal vein occlusion. PATIENTS AND METHODS: Prospective noncomparative single-center study. Analysis of ten eyes of ten consecutive patients whose visual acuity was 0.1 or less. They underwent fluorescein angiography, visual field testing by automated perimetry, and macular thickness analysis by optical coherence tomography preoperatively at 3 months and at 6 months postoperatively. RESULTS: Mean visual acuity on an ETDRS chart increased from 30+/-12 points preoperatively to 42+/-15 points at the 3-month visit, (p=0.03), and mean macular thickness decreased from 580+/-150 micro m to 361+/-52 micro m (p=0.04). All patients had clinical improvement as determined by fundus examination and fluorescein angiography. An improvement in the central visual field was observed in all eyes. Mean visual acuity of the five patients followed-up for 6 months was 52.8+/-20 points. No visual loss was observed. None of the patients underwent laser photocoagulation or has presented with neovascularization so far. Optociliary veins developed in three eyes and a retinochoroidal anastomosis within the disk incision was observed in two eyes. CONCLUSION: These preliminary results are encouraging when compared to the reported natural progression of severe central retinal vein occlusion. A bypass of the site of occlusion is a possible mechanism for radial optic neurotomy. A randomized study should be conducted to assess the efficacy of radial optic neurotomy and determine the best candidates for surgery.     

Radial optic neurotomy for central retinal vein occlusion: 117 consecutive cases

PURPOSE: Venous occlusive disease is the second leading cause of permanent retinal vascular blindness. The anatomy of the optic disk including the cribriform plate and scleral ring may contribute to the development of retinal vasoocclusive diseases. Neurovascular compression within the confined space at this location (scleral outlet) may play a pathoetiologic role in central retinal vein occlusion (CRVO). We developed a surgical procedure (radial optic neurotomy [RON]) to open this space and relieve pressure on the central retinal vein. METHODS: Pars plana vitrectomy with RON was performed on 117 consecutive patients with CRVO and severe loss of vision (defined as 20/200 or worse). Patients were observed with serial fundus photography, fluorescein angiography, determination of Snellen visual acuity, and biomicroscopy for anterior segment neovascularization. RESULTS: There were no serious complications noted with this procedure. Anatomical and clinical improvement as determined by fundus examination, fundus photography, and fluorescein angiography was found in 95% of patients. Snellen visual acuity improved by an average of 2.5 lines (range, 1-12 lines) in 71% of patients. Two or more lines were gained in 53% of patients, and > or = 4 lines were gained in 25%. Anterior segment neovascularization was found in 6% of patients with CRVO. CONCLUSIONS: Surgical decompression of CRVO via RON is a technically feasible and safe procedure that was associated with anatomical resolution of CRVO in 95% patients and improved visual function in 71%.     

放射状视神经切开术治疗缺血型视网膜中央静脉阻塞合并黄斑水肿的疗效观察

目的 观察放射状视神经切开术(RON)治疗缺血型视网膜中央静脉阻塞(CRVO)合并黄斑水肿的效果。 方法 回顾分析6例缺血型CRVO合并黄斑水肿患者行玻璃体切割联合RON治疗的临床资料，对比观察患者手术前后视力、荧光素眼底血管造影(FFA)、光相干断层扫描(OCT)检查结果,重点观察黄斑厚度、视网膜静脉充盈、视网膜出血和视盘水肿的改善情况。 结果 6例患者手术后视力均有不同程度提高，视网膜出血明显减少，5例患者黄斑水肿不同程度改善，4例患者视网膜静脉扩张改善，2例合并视盘水肿的患者手术后视盘水肿消失。 结论 RON能够改善缺血型CRVO合并的黄斑水肿，但不能排除治疗效果和玻璃体切割手术有关。(中华眼底病杂志,2005,21:3-5)