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 microm (510-737 microm) and postoperative fovea thickness was 217.60 +/- 47.33 microm (164-285 microm). CONCLUSIONS: Vitrectomy with AV sheathotomy can be one treatment option for the patients with recurrent macular edema in BRVO.     

Visual acuity and multifocal electroretinographic changes after arteriovenous crossing sheathotomy for macular edema associated with branch retinal vein occlusion

PURPOSE: To evaluate the influence of arteriovenous (AV) sheathotomy on retinal function with central multifocal electroretinography (mfERG) in eyes with macular edema secondary to branch retinal vein occlusion (BRVO). METHODS: Fifteen patients (15 eyes) who underwent AV sheathotomy for macular edema secondary to BRVO were included in the study. Best-corrected visual acuity and mfERG responses from the most central seven hexagons were analyzed before and 6 months after the operation. RESULTS: The mean preoperative Early Treatment Diabetic Retinopathy Study (ETDRS) score +/- SD was 34.1 +/- 12.7 letters (Snellen equivalent, 20/50) and significantly improved up to 40.5 +/- 10.9 letters (Snellen equivalent, 20/40) at 6 months after AV sheathotomy (P = 0.027, Wilcoxon signed rank test). The mean preoperative P1 amplitude +/- SD of the most central 7 hexagons was 39.30 +/- 10.86 nV/deg(2) for the affected eye versus 47.72 +/- 6.67 nV/deg(2) for the normal fellow (control) eye (P = 0.013, Mann-Whitney U test) and significantly increased up to 50.71 +/- 15.58 nV/deg at 6 months after the operation (P = 0.014, Wilcoxon signed rank test). Significant correlations between preoperative and postoperative ETDRS score and preoperative P1 amplitude were present (r = 0.929, P < 0.001; r = 0.768, P = 0.001; respectively [Spearman correlation]). CONCLUSIONS: AV sheathotomy improved macular function and anatomical outcome as measured by ETDRS score and mfERG responses in patients with macular edema due to BRVO.     

Retinal blood flow and macular edema after radial optic neurotomy for central retinal vein occlusion

PURPOSE: To determine the effect of radial optic neurotomy (RON) on retinal blood flow (RBF) and macular edema in eyes with a central retinal vein occlusion. DESIGN: Prospective interventional study. METHODS: Seven eyes of seven patients with central retinal vein occlusion underwent RON and vitrectomy and were followed for at least 6 months. The RBF was calculated from dye dilution curves of video fluorescein angiograms. The foveal thickness was determined by optical coherence tomography. RESULTS: At 1 week after surgery, the RBF was significantly reduced from 28.5 +/- 5.4 to 21.1 +/- 6.6 pixel(2)/s (P < .01). At 6 months after surgery, the RBF (26.0 +/- 7.7 pixel(2)/s) was not significantly different from the preoperative RBF, although chorioretinal anastomoses were found in all seven eyes. The foveal thickness was significantly decreased from 711 +/- 271 to 488 +/- 182 mum (P = .03). The postoperative visual acuity was better than the preoperative visual acuity by two or more lines in three out of seven eyes, and was worse in two eyes. CONCLUSIONS: Neither RON nor chorioretinal anastomoses improved the RBF but macular edema was improved. These findings suggest that removal of the vitreous could reduce macular edema as in diabetic macular edema. However, we cannot exclude the possibility that the changes represent the natural course of this disease.     

Vitrectomy with or without arteriovenous adventitial sheathotomy for macular edema associated with branch retinal vein occlusion

PURPOSE: compare the results of vitrectomy with or without arteriovenous (AV) crossing sheathotomy for macular edema associated with branch retinal vein occlusion (BRVO). DESIGN: Interventional case series. METHODS: A retrospective study of 36 eyes with BRVO-associated macular edema. Twenty eyes underwent AV sheathotomy (AS group), and 16 eyes underwent posterior vitreous detachment (PVD group). Best-corrected visual acuity (BCVA), fluorescein angiography (FA), and optical coherence tomography to determine foveal thickness were conducted preoperatively and at 12 months postoperatively. RESULTS: The mean postoperative BCVAs were significantly better in both the AS and the PVD group (P = .008 and P = .001, respectively). Foveal thickness decreased significantly 1 month after surgery in both groups (P = .002 and P = .007) and continued to decrease up to 12 months. The postoperative mean BCVA and improvement of BCVA and foveal thickness were not significantly different for the two groups at any postoperative period. Postoperative FA showed reperfusion of the occluded vein in 10 eyes in the AS group and 2 eyes in the PVD group, and formation of shunt vessels at the AV crossing site or around the macular region in all of the other eyes of both groups. CONCLUSIONS: Both AV sheathotomy and simple PVD significantly reduced macular edema associated with BRVO. However, there was no significant difference in the improvement of macular function following either procedure. Postoperative improvement of retinal circulation by either reperfusion of the occluded vein or collateral vessel formation was found. This accounted for functional and morphologic improvements.     

Triamcinolone acetonide with vitrectomy for treatment of macular edema associated with branch retinal vein occlusion

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.     

动静脉鞘膜切开治疗视网膜分支静脉阻塞

目的观察动静脉鞘膜切开术治疗视网膜分支静脉阻塞的临床效果.方法对3例(3只眼)视力低于0.1的视网膜分支静脉阻塞患者进行平坦部玻璃体切割术和动静脉鞘膜切开术.结果 3只眼术后玻璃体清亮,视力均有不同程度的提高,视网膜内出血和黄斑水肿明显减轻,无手术并发症发生.结论动静脉鞘膜切开术是治疗视力较差的视网膜分支静脉阻塞的有效方法.     

Transvitreal limited arteriovenous-crossing manipulation without vitrectomy for complicated branch retinal vein occlusion using 25-gauge instrumentation

PURPOSE: To evaluate a new technique, 25-gauge transvitreal limited arteriovenous-crossing manipulation without vitrectomy (LAM), for the treatment of branch retinal vein occlusion (BRVO) complicated by macular hemorrhage and/or macular edema recalcitrant to grid laser photocoagulation. METHODS: Twelve eyes of 12 patients underwent LAM for BRVO performed by a single surgeon (M.S.H.) using the 25-gauge nitinol flexible-extendable blunt pick. The presence or absence of intraoperative reperfusion visualization, pre- and postoperative visual acuity, macular thickness as measured by optical coherence tomography, intraocular pressure, and lens status were evaluated. RESULTS: Restoration of blood flow was noted in all patients and was based on intraoperative reestablishment of a red column of erythrocytes through the previously closed vessel. Mean visual acuity improved from 20/200 (logarithm of the minimal angle of resolution [LogMAR] +/- SD, 1.00 +/- 0.32) preoperatively to 20/70 (LogMAR +/- SD, 0.56 +/- 0.28) (P = 0.0003) at the final visit. Eleven (92%) of 12 eyes had >or=2 lines of visual improvement. Five eyes (45%) had final visual acuity of 20/50 or better. Mean macular thickness +/- SD improved from 401.0 +/- 73.2 to 178.7 +/- 19.6 microm (P < 0.0001) at the final visit. No statistically significant difference was noted in cataract progression or intraocular pressure. Mean follow-up +/- SD was 49.9 +/- 19.6 weeks. All patients were observed for at least 12 weeks. CONCLUSION: LAM may achieve outcomes comparable with those of arteriovenous adventitial sheathotomy for complicated BRVO.     

Trans-tenon retrobulbar triamcinolone injection for macular edema associated with branch retinal vein occlusion remaining after vitrectomy

PURPOSE: To evaluate the effectiveness and safety of trans-Tenon retrobulbar triamcinolone injection for macular edema associated with branch retinal vein occlusion (BRVO) after vitrectomy. DESIGN: Prospective interventional case series. METHODS: The study included 20 eyes of 20 patients with BRVO, characterized by macular edema lasting more than 3 months after vitrectomy. Trans-Tenon retrobulbar injection of 40 mg triamcinolone was performed, and visual and anatomic responses were evaluated. RESULTS: Mean foveal thickness was 499.4 +/- 209.1 microm preoperatively, 281.8 +/- 110.1 microm at 2-week follow-up, and 196.9 +/- 92.1 microm at 6-month follow-up (P < .0001, at 2 weeks and 6 months, paired t test). Improvement of visual acuity by at least 0.2 logMAR (logarithm of the minimum angle of resolution) was seen in 14 (70%) of the 20 eyes. CONCLUSIONS: Trans-Tenon retrobulbar injection of triamcinolone may be an alternative for additional treatment of eyes with BRVO that remains after vitrectomy.     

Evaluation of arteriovenous crossing sheathotomy for branch retinal vein occlusion by fluorescein videoangiography and image analysis

PURPOSE: We quantitatively evaluated the effects of arteriovenous (A/V) crossing sheathotomy on retinal circulation in patients with branch retinal vein occlusion (BRVO) accompanied by macular edema. DESIGN: Interventional case series. METHODS: In 18 consecutive patients (18 eyes) with BRVO accompanied by macular edema who underwent A/V crossing sheathotomy between August 1999 and April 2002, changes in retinal circulation after the surgery were evaluated by fluorescein videoangiography with a scanning laser ophthalmoscope and by image analysis using dye dilution technique. At a venule distal to the responsible A/V crossing site and a normal venule, the circulation time (T50) from the beginning of filling to 50% filling of the peak intensity was calculated. The time difference (DeltaT50) between T50 at the point on the affected venule and that at the point on the normal venule, which represents the filling delay at the venule distal to the A/V crossing site, was compared between before and early after the surgery. RESULTS: The preoperative DeltaT50 was 1.36 +/- 1.15 seconds (mean +/- SD), and the postoperative DeltaT50 was 0.72 +/- 0.77 seconds (P =.035, paired t test). In 11 of the 18 eyes, DeltaT50 decreased by 20% or more after the surgery. In the other 7 eyes, DeltaT50 was unchanged or slightly increased after the surgery. CONCLUSIONS: Although a randomized controlled study is needed to confirm the effectiveness of A/V crossing sheathotomy on visual function, this technique could be effective for improving the delay in perfusion in the affected venule.     

Serous macular detachment in branch retinal vein occlusion

PURPOSE: To evaluate the relationship between the extent of branch retinal vein occlusion (BRVO) and the incidence of serous retinal detachment (SRD) in the macular area. METHODS: One hundred nine eyes of 109 consecutive patients with BRVO comprised the study population. These eyes were characterized as having either macular BRVO or major BRVO. We compared the tomographic macular findings between the two groups. RESULTS: Thirty-nine eyes had macular BRVO, and 70 eyes had major BRVO. The incidence of SRD was higher in the group with major BRVO (63%) than in the group with macular BRVO (21%) (P < 0.001). The incidence of cystoid macular edema was similar in both groups (macular BRVO, 97%; and major BRVO, 90%). Foveal thickness of major BRVO (610 +/- 190 micro m) was significantly greater than that of macular BRVO (500 +/- 140 micro m) (P < 0.01). There was no significant difference in thickness of the neurosensory retina between the group with macular BRVO (450 +/- 120 micro m) and the group with major BRVO (480 +/- 140 micro m). CONCLUSIONS: Serous macular detachment occurs more frequently in major BRVO than in macular BRVO. Vascular leakage from congested retinal veins outside the macular area appears to be a major source of subretinal fluid at the fovea.     

Intravitreal tissue plasminogen activator to treat macular edema associated with branch retinal vein occlusion

PURPOSE: To evaluate the efficacy of intravitreal tissue plasminogen activator (tPA) injection for branch retinal vein occlusion (BRVO). DESIGN: Retrospective, interventional case series. METHODS: Seventeen eyes presenting with macular edema caused by BRVO were treated with an intravitreal tPA (Monteplase, 40 k IU) injection. We assessed the visual acuity (VA) and foveal thickness measured with optical coherence tomography. RESULTS: The mean duration of symptoms before surgery was 3.6 +/- 3.8 weeks. The mean logMAR VA significantly improved from 0.603 +/- 0.327 at baseline to 0.388 +/- 0.248 (P < .01) at one month and 0.359 +/- 0.319 (P < .05) at six months. The mean foveal thickness significantly decreased from 738 +/- 156 microm at baseline to 454 +/- 213 microm (P < .001) at one month and 253 +/- 164 microm (P < .001) six months. CONCLUSION: Intravitreal tPA injection may be an effective treatment for resolving macular edema and improving the VA in BRVO.     

25-gauge vitrectomy and triamcinolone acetonide-assisted internal limiting membrane peeling for chronic cystoid macular edema associated with branch retinal vein occlusion

PURPOSE: To evaluate the efficacy of 25-gauge vitrectomy and triamcinolone acetonide (TA)-assisted internal limiting membrane (ILM) peeling for chronic cystoid macular edema (CCME) in branch retinal vein occlusion (BRVO). METHODS: Thirty-four patients (38 eyes) presenting with CCME in BRVO were treated prospectively by 25-gauge vitrectomy and ILM peeling. Change in best-corrected visual acuity (BCVA) and CCME status were evaluated preoperatively and postoperatively at 1 month, 2 months, 3 months, 4 months, 5 months, 6 months, and 7 months. RESULTS: Mean postoperative logMAR BCVAs +/- SD were 0.69 +/- 0.42, 0.65 +/- 0.41, 0.59 +/- 0.32, 0.39 +/- 0.27, 0.35 +/- 0.31, 0.32 +/- 0.28, and 0.32 +/- 0.31 at the seven follow-up months, respectively. Mean foveal thicknesses +/- SD were 443 +/- 60 microm, 212 +/- 67 microm, 188 +/- 41 microm, 176 +/- 53 microm, 173 +/- 41 microm, 171 +/- 39 microm, and 170 +/- 41 microm at the 7 follow-up months, respectively. Compared with before surgery, BCVA improved, and CCME was absorbed significantly (P < 0.01, Dunnett test). Foveal thickness and logMAR BCVA 7 months after surgery had a significant negative linear correlation (r = -0.81, P < 0.01; Spearman rank correlation). CONCLUSIONS: Twenty-five-gauge vitrectomy with TA-assisted ILM peeling is generally effective in reducing macular edema and improving BCVA for CCME in BRVO for at least 7 months.     

Long-term outcomes of vitrectomy with or without arteriovenous sheathotomy in branch retinal vein occlusion

PURPOSE: To evaluate the long-term effect of vitrectomy with or without arteriovenous sheathotomy for macular edema secondary to branch retinal vein occlusion (BRVO). METHODS: The study was a prospective, randomized, comparative, interventional case series of 36 patients (36 eyes) who underwent pars plana vitrectomy with or without arteriovenous sheathotomy for macular edema due to BRVO of 相似文献   

Arteriovenous crossing sheathotomy versus intravitreal triamcinolone acetonide injection for treatment of macular edema associated with branch retinal vein occlusion

PURPOSE: To compare the functional and anatomical outcomes of arteriovenous (AV) sheathotomy and intravitreal triamcinolone acetonide (IVTA) injection in the treatment of macular edema associated with branch retinal vein occlusion (BRVO). METHODS: Forty eyes of 40 patients with macular edema secondary to BRVO were randomized into two treatment groups. A total of 20 patients received AV sheathotomy (sheathotomy group), and the second group of 20 patients was treated with IVTA (IVTA group). Early Treatment Diabetic Retinopathy Study (ETDRS) visual acuity (VA) score, total macular volume measured, and foveal thickness by 3rd generation optical coherence tomography (OCT3) were evaluated as main outcome measurements. RESULTS: The average changes in ETDRS scores, total macular volumes, and foveal thicknesses compared to baseline values, were significant 3 months and 6 months after treatment in both groups (P < 0.05, paired t-test), but only the IVTA group showed significant improvements 1 month after treatment. The between-group differences in average ETDRS score, total macular volume, and foveal thickness changes were significantly better at 1 month after treatment in the ITVA group (P = 0.026, P < 0.001, P = 0.001, respectively, Student's t-test), at which time IVTA patients had better vision and anatomical outcomes than did those in the sheathotomy group. CONCLUSIONS: After either AV sheathotomy or IVTA treatment, patients with macular edema secondary to BRVO showed similar functional and anatomical outcomes 6 months later. When the cost and the risks of vitreoretinal surgery are considered, IVTA treatment may be a better treatment option, as the drug yields better short-term outcomes.     

动静脉鞘膜切开术治疗视网膜分支静脉阻塞的初步报告

目的
观察动静脉鞘膜切开术（arteriovenous sheathotomy）治疗视网膜分支静脉阻塞(branch retinal vein occlusion, BRVO)的临床疗效。
方法
分析6例BRVO患者经行睫状体平坦部玻璃体切割、玻璃体后皮质剥离、BRVO部位的动静脉鞘膜切开、动静脉分离等治疗的6只患眼术中所见以及随访3～12个月的视力、眼底彩色照相、荧光素眼底血管造影（fundus fluorescein angiography, FFA）、光学相干断层扫描（optical coherence tomography, OCT）、多焦视网膜电图（multifocal electroretinography，mERG）等检查的临床资料。
结果
手术中，切开动静脉鞘膜、分离动静脉时，均见近段静脉充盈增加。 随访期间内，5例患者的视力显著提高（最佳矫正视力为1.5），眼底彩色照相、FFA检查发现视网膜出血明显吸收，血管变直，荧光素渗漏减少，但有3例患者手术后3个月在鞘膜切开部位的远段FFA检查可见大片毛细血管闭塞区；OCT检查显示黄斑水肿较手术前大大减轻或消除；mERG检查显示黄斑区反应振幅明显高于手术前。1例患者因反复玻璃体积血而再次手术。
结论
动静脉鞘膜切开术治疗BRVO能提高患者视力，改善静脉回流，减轻黄斑水肿，但手术后
视网膜毛细血管的无灌注区的改善却不明显。 (中华眼底病杂志，2002，18：6-9)     

Evaluation of arteriovenous crossing sheathotomy for decompression of branch retinal vein occlusion

PURPOSE: To report the effects of arteriovenous adventitial sheathotomy on anatomical and functional improvements in patients with macular oedema due to branch retinal vein occlusion (BRVO). METHODS: Pars plana vitrectomy and arteriovenous sheathotomy was performed on 11 patients with BRVO who had vision loss due to macular oedema. Ten patients with macular oedema due to BRVO and who have been treated with grid laser photocoagulation were included in the control group. The measurement of visual acuity with ETDRS chart was taken preoperatively and at 1, 3, 6, and 9 months follow-up in the study group and at 1, 3, 6, and 9 months after grid laser in the control group. RESULTS: The mean preoperative logMAR visual acuity was 0.84+/-0.3 in the surgical group and 1.06+/-0.4 in the control group. The postoperative mean logMAR visual acuity was 0.41+/-0.2, 0.40+/-0.2, 0.40+/-0.3, and 0.36+/-0.3 at 1, 3, 6, and 9 months follow-up, respectively. In the control group the postlaser mean logMAR visual acuity was 0.92+/-0.3, 0.87+/-0.4, 0.85+/-0.3, and 0.82+/-0.3 at 1, 3, 6, and 9 months follow-up, respectively. The improvements of visual acuity in both groups were statistically significant when compared to pretreatment (P=0.003 and P=0.007 at 9 months in the study and control group, respectively). CONCLUSION: Arteriovenous sheathotomy for decompression of BRVO in patients who have vision loss due to macular oedema was safe and effective for anatomical and functional improvement and resulted in significantly better visual outcomes than a matched control group of laser-treated eyes.     

Foveal photoreceptor layer in eyes with persistent cystoid macular edema associated with branch retinal vein occlusion

PURPOSE: To study the correlation of visual acuity and the foveal photoreceptor layer in eyes with persistent cystoid macular edema associated with branch retinal vein occlusion (BRVO). DESIGN: Retrospective chart review. METHODS: We studied retrospectively the medical records of 42 eyes of 42 patients with persistent cystoid macular edema secondary to BRVO, eyes in which the foveal thickness was greater than 250 microm at final examination. On the vertical image obtained by optical coherence tomography at the final examination, we measured thickness of the foveal photoreceptor layer that was beneath the foveal cystoid spaces. We also assessed status of the junction between inner and outer segments of the photoreceptors (IS/OS) in the fovea. RESULTS: The photoreceptor layer beneath the foveal cystoid spaces was detected as a distinct layer with thickness varying between 33 microm and 124 microm (mean, 71.1 +/- 26.8 microm). Final visual acuity showed no correlation with total foveal thickness (r = 0.336, P = .092). However, it did show a close correlation with thickness of the foveal photoreceptor layer (r = -0.571, P < .0001). Of the 42 eyes, 15 showed a continuous IS/OS line in the fovea. Visual acuity in these eyes with a continuous IS/OS line in the fovea was significantly better than that in eyes with a discontinuous or interrupted IS/OS line (P < .0001). CONCLUSIONS: Both the thickness and the integrity of the foveal photoreceptor layer are associated with visual function in eyes with persistent cystoid macular edema associated with BRVO.     

Efficacy of intravitreal triamcinolone for the treatment of macular edema secondary to branch retinal vein occlusion in eyes with or without grid laser photocoagulation

PURPOSE: To evaluate the efficacy of primary and secondary (following grid laser photocoagulation) intravitreal triamcinolone acetonide (IVTA) injection for the treatment of macular edema associated with branch retinal vein occlusion (BRVO). METHODS: Eyes with macular edema secondary to BRVO and best-corrected visual acuity (BCVA) worse than 20/40 were included. Eyes eligible for Branch Retinal Vein Occlusion Study (BVOS) guidelines received grid laser treatment first. Those that were not improved at least two lines following grid laser or that did not meet those guidelines received 4 mg IVTA injection. The efficacy of IVTA treatment was assessed by analyzing the change in BCVA and reduction in central macular thickness (CMT) measured by optical coherence tomography. Intraocular pressure (IOP) spikes and other complications were recorded. RESULTS: The data from 37 eyes were included; in 12 of them IVTA injection was given after grid laser while 25 of them received IVTA as a primary treatment. Mean follow-up was 9.6 +/- 4.5 months. BCVA was 0.06 +/- 0.30 and 0.17 +/- 0.50 in the primary and secondary IVTA injection groups, respectively. In the primary injection group, there was a statistically significant gain in BCVA throughout the follow-up (P < 0.05), while a small increase in BCVA was noted only at the third month visit in the secondary IVTA injection group (P = 0.04). Average CMT were 434.8 +/- 122.1microm and 389.0 +/- 171.9 microm before IVTA injection in the two groups, respectively. In the primary IVTA injection group, CMT decreased at 1 month following IVTA injection and remained statistically significant until the sixth month visit (P < 0.05). In the secondary IVTA injection group, a slight reduction in CMT was noted only in the first month visit (P = 0.02). Pre-IVTA BCVA was found to be the single statistically significant predictor of BCVA gain following IVTA injection. In 8 patients (21.6%), the IOP increased above 25 mmHg postoperatively, and was successfully managed by medical treatment. Endophthalmitis did not develop in any of the patients. CONCLUSION: IVTA injection produced a significant reduction of macular edema in eyes with BRVO either with or without prior grid laser treatment. Reduction of CMT increased the BCVA in most of the eyes receiving IVTA primarily, while only a slight improvement of BCVA was found in eyes with prior grid laser. The IVTA effect was transient. Larger studies are necessary to find the best approach (either grid laser or IVTA) to patients with macular edema associated with BRVO.     

The efficacy of arteriovenous adventitial sheathotomy for macular edema in branch retinal vein occlusion

PURPOSE: To examine the efficacy of arteriovenous adventitial sheathotomy (or arteriovenous decompression) for macular edema (ME) in branch retinal vein occlusion (BRVO). PATIENTS AND METHODS: Eighty-three patients (83 eyes) who had ME in BRVO for 26 weeks or less underwent pars plana vitrectomy and internal limiting membrane dissection and were followed post-operatively for more than one year. The eighty-three eyes were divided into 38 eyes with sheathotomy(sheathotomy group) and 45 eyes without sheathotomy(non-shesthotomy group). The absorption period for ME and the difference between pre- and postoperative visual acuity(VA) at one year in the two groups were compared, and statistically significant factors were extracted. RESULTS: The mean absorption period for ME was 3.4 months in the sheathotomy group and 4.2 months in the non-sheathotomy group, and the mean difference between pre- and postoperative VA at one year was 0.37 and 0.28, respectively. There was no significant difference between the two groups. There was no significant factor related to the absorption period for ME, but the difference between preoperative VA and postoperative VA at one year was significant. CONCLUSION: Sheathotomy may have no additional effect on the absorption of ME or the improvement of VA after vitrectomy for BRVO.     

Efficiency of surgical treatment for chronic macular edema due to branch retinal vein occlusion

INTRODUCTION: Internal limiting membrane peeling has recently given interesting results in the management of macular edema in diabetic patients, even in the absence of vitreomacular tractions. This study was conducted to evaluate the results of a surgical treatment for macular edema resulting from branch retinal vein occlusion. MATERIAL AND METHODS: A nonrandomized prospective study was conducted between March 2001 and April 2002 on 12 eyes of 12 consecutive patients with a visual acuity of 20/40 or less resulting from branch retinal vein occlusion with macular edema. Internal limiting membrane peeling associated with arteriovenous crossing sheathotomy was performed on six eyes and internal limiting membrane peeling alone was performed on six eyes. Patients were tested with ETDRS visual acuity, fluorescein angiography, automated perimetry, and OCT pre- and postoperatively (at 3 and 6 months). RESULTS: At 6 months, postoperative visual acuity was improved in all patients (mean VA=20/40; range, 20/125-20/20), with an average gain of three lines of vision (or 14 ETDRS points) (p=0.002). Fundus examination and fluorescein angiography results were improved in all patients. At 6 months, on automated field testing, the mean corrected defect improved from 3.4+/-0.9dB to 2.3+/-0.9dB (p=0.008). On OCT, mean foveal thickness decreased from 419+/-57 micro m to 233+/-10 micro m (p=0.02). No difference was noted between simple vitrectomy with internal limiting membrane peeling and arteriovenous crossing sheathotomy in terms of visual acuity (p=0.5), visual field (p=0.2), or foveal thickness (p=0.6) improvement. CONCLUSION: Our findings suggest that internal limiting membrane removal for macular edema may improve the functional prognosis in patients with branch retinal vein occlusion. Adventitial sheathotomy did not yield further functional benefits in these cases.