Surgical decompression of branch retinal vein occlusion via arteriovenous crossing sheathotomy: a prospective review of 15 cases

BACKGROUND: Branch retinal vein occlusion (BRVO), the second most common vascular disorder of the retina, typically occurs at arteriovenous (A/V) crossings where the arteriole and venule share a common adventitial sheath. Mechanical narrowing of the venous lumen at these intersections is thought to play a pathoetiologic role in BRVO. METHODS: We performed surgical decompression of BRVO via A/V crossing sheathotomy in 15 patients with decreased visual acuity due to macular hemorrhage, edema, and ischemia. Reperfusion of the retina was achieved by surgically separating the overlying retinal arteriole from the venule via vitrectomy and adventitial sheathotomy techniques. RESULTS: Intraoperative decompression of the A/V crossing was achieved in all 15 patients. All patients showed clinical improvement as determined by fundus examination, photography, and fluorescein angiography. Postoperative visual acuities were equal or improved in 80% of patients. Ten of the 15 subjects (67%) had improved visual acuity with an average gain of four lines of vision. CONCLUSION: Surgical decompression of BRVO via A/V crossing sheathotomy is a technically feasible procedure that can result in rapid reperfusion of the retina. Resolution of macular hemorrhage, edema, and ischemia may improve visual prognosis in patients with this common retinal vascular disorder.     

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.     

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.     

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.     

Effect of arteriovenous sheathotomy on retinal blood flow and macular edema in patients with branch retinal vein occlusion

PURPOSE: To determine the effect of arteriovenous sheathotomy on retinal blood flow (RBF) in eyes with branch retinal vein occlusion (BRVO). DESIGN: Interventional case series. METHODS: Seven eyes of 7 patients with BRVO underwent sheathotomy and were followed for more than 6 months. RESULTS: At 1 week postoperatively, the RBF in the affected vessels was significantly improved from 14.1 +/- 5.7 to 27.3 +/- 11.3 pixel(2)/sec (P < 0.01), and the foveal thickness (FT) was significantly reduced from 536 +/- 84 to 366 +/- 134 microm (P = 0.03). However, the RBF was reduced again to 11.7 +/- 7.7 pixel(2)/sec at 1 month postoperatively, and the FT was increased to 424 +/- 184 microm. CONCLUSIONS: Arteriovenous sheathotomy led to a transient improvement of the RBF and was effective in reducing macular edema. It is not clear whether the transient effect of sheathotomy affects the long-term visual acuity and macular edema.     

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   

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)     

Preliminary Clinical Observation of Arteriovenous Sheathotomy for Treatment of Branch Retinal Vein Occlusion

Purpose: To document the anatomic and functional improvement of six patients with branch retinal vein occlusion (BRVO) following successful arteriovenous adventitial sheathotomy (AAS).Methods: Retrospective study of 6 patients (6 eyes) with BRVO treated with AAS. All patients were not eligible for laser photocoagulation and had both macular edema and intraretinal hemorrhage. The visual acuity was in the range of 0. 4 to 0. 02. All patients underwent pars plana vitrectomy and AAS. The clinical improvement was determined by fundus photograph, fluorescein angiography (FAG), optical coherence tomography (OCT) and multifocal electroretinography (ERG) . All patients were followed postoperatively for an average of 20 months ranging from 12 to 24 months. Results: Sheathotomy and decompression of the arteriole/venule (A/V) crossing were achieved in all 6 patients. 5 patients have improved their best-corrected visual acuity 4 lines or more. The best one could reach to 1. 0. One month after the operation, fundus p     

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.     

Evaluation of radial optic neurotomy for central retinal vein occlusion by indocyanine green videoangiography and image analysis

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.     

Branch retinal vein occlusion: pathogenesis, visual prognosis, and treatment modalities

In branch retinal vein occlusion (BRVO), abnormal arteriovenous crossing with vein compression, degenerative changes of the vessel wall and abnormal hematological factors constitute the primary mechanism of vessel occlusion. In general, BRVO has a good prognosis: 50-60% of eyes are reported to have a final visual acuity (VA) of 20/40 or better even without treatment. One important prognostic factor for final VA appears to be the initial VA. Grid laser photocoagulation is an established treatment for macular edema in a particular group of patients with BRVO, while promising results for this condition are shown by intravitreal application of steroids or new vascular endothelial growth factor inhibitors. Vitrectomy with or without arteriovenous sheathotomy combined with removal of the internal limiting membrane may improve vision in eyes with macular edema which are unresponsive to or ineligible for laser treatment.     

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.     

Management of branch retinal vein occlusion with vitrectomy and arteriovenous adventitial sheathotomy,the possible role of surgical posterior vitreous detachment

Background To analyze the results of vitrectomy and adventitial sheathotomy in the management of branch retinal vein occlusion (BRVO). This is a nonrandomized interventional case series.Methods Patients with BRVO with progressive decrease in visual acuity underwent surgery and were prospectively evaluated in two centers. Surgical procedure included a 3-port pars plana vitrectomy, removal of the internal limiting membrane and arteriovenous crossing sheathotomy. Clinical evaluation consisted of best-corrected visual acuity, fluorescein angiography and optical coherence tomography.Results Thirteen eyes were analyzed consecutively. An improvement in visual acuity of two ETDRS lines or more was observed in nine eyes (69%). The mean gain was 1.9 ETDRS lines. The absence of previous posterior vitreous detachment (PVD), poor initial visual acuity and the presence of retinal ischemia were correlated to the improvement in vision (P=0.014, P=0.002 and P=0.052, respectively). Eyes with initial PVD had a mean loss postoperatively of –5.7 lines, but eyes without PVD experienced a gain of 4.2 lines (P<0.001). Macular edema decreased significantly (preoperative thickness: 714 µm, postoperative thickness: 353 µm, P=0.04), whereas the aspect of the vein at the crossing and the non-perfused area remained unchanged.Conclusion Vitrectomy with sheathotomy seems to be of benefit in the management of BRVO, particularly in eyes with no previous PVD, and the main postoperative feature was the decrease in macular edema. The surgical detachment of posterior hyaloid could be as important (or more) as the sheathotomy itself. Further studies are needed to define the most efficient surgical management of BRVO.     

Management of macular edema in branch retinal vein occlusion with sheathotomy and recombinant tissue plasminogen activator

PURPOSE: The common adventitial sheath that surrounds the retinal venule and arteriole at the crossing site plays a crucial role in branch retinal vein occlusion (BRVO). The purpose of this study was to report the surgical recanalization of the occluded vein using a bimanual technique and recombinant tissue plasminogen activator (tPA) and its effect on final visual acuity. METHODS: Arteriovenous sheathotomy was performed, using a bimanual technique, followed by fluid-air exchange and injection of 25 mg of recombinant tPA over the area of the occluded vein. RESULTS: Intraoperative sectioning of the common arteriovenous sheath was achieved in all 40 patients. Thrombus release was observed in 11 cases (27.5%) and was correlated with early surgery (P < 0.001) and better final visual recovery (P < 0.06). Optical coherence tomography showed macular thickness that decreased by greater than 40% in 31 patients (77.5%) compared with preoperatively, and correlated to postoperative visual acuity (P < 0.001). The mean visual acuity increased from 20/100 to 20/40, with 70% of patients gaining three or more lines of visual acuity (Pearson 0.378, P = 0.016). CONCLUSION: Surgical venous decompression and injection of recombinant tPA may effectively manage macular edema secondary to BRVO, thus improving anatomic and visual outcome. Early surgical intervention may obtain maximum final visual recovery.     

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.     

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.     

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.     

视网膜血管鞘膜切开治疗视网膜分支静脉阻塞

目的探讨玻璃体切除联合视网膜血管鞘膜切开术对视网膜分支静脉阻塞的疗效。方法对39例（39眼）视网膜分支静脉阻塞行标准的三通道玻璃体切除手术。切除后玻璃体,升高眼压以减少出血。利用一弯头的MVR刀切开内界膜,在动静脉交叉点外远端100～200μm处切开视网膜内层,然后将动脉和神经纤维行钝性分离。最后,利用MVR刀将动静脉交叉处的血管外膜切开,当动脉与其后的静脉分离,并可被挑起,表明分离成功。气一液交换后注入惰性气体0．8mL于玻璃体腔。在术后1、2．3、6、12个月进行视力、荧光素眼底血管造影、视野及黄斑部光学相干断层扫描等检查。结果39例中,有32例分支阻塞的血管获得完全再通,3例部分再通,4例血管仍然阻塞;其中视力提高者28例,视力保持不变者9例,2例因发生视网膜脱离视力下降。视野及囊样黄斑水肿较术前改善的有18例。结论玻璃体切除联合视网膜血管鞘膜切开治疗视网膜分支静脉阻塞是一种安全有效的方法。     

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.     

视网膜分支静脉阻塞合并视网膜脱离的临床分析

目的 分析视网膜分支静脉阻塞(BRVO)合并视网膜脱离(RD)的临床特征及有效的治疗方法.方法 收集2004年11月至2007年10月治疗的有完整随访观察资料的18例(18只眼)BRVO合并RD的病例,采用常规三通道闭合式玻璃体切割手术,其中6例联合白内障超声乳化吸出术,合并黄斑裂孔的患眼行内界膜剥离,术后1、2周,1、2、3、6月随访,平均随访4.8月,观察患者的视力、眼底、眼压、玻璃体后脱离,术中术后并发症、及术后视网膜复位等情况.结果 全部病例于术中均发现裂孔,单个孔、多发孔各9例,孔源性视网膜脱离17例,牵引性视网膜脱离1例,黄斑孔5例,黄斑孔中合并黄斑囊样水肿1例,合并黄斑前膜2例.18例中发现纤维血管膜生长的15例,玻璃体不完全性后脱离粘连牵拉视网膜的12例,黄斑水肿6例,其中合并黄斑前膜2例.BRVO发生于颞上的6例,鼻上6例,上半侧3例,颞下2例,颢上合并颞下1例.18例中术后视力提高12例,视力稳定3例,视力下降3例,术后最佳矫正视力HM3例、0.1-0.39例、0.3以上6例.一次手术视网膜复位的16例,2例于硅油取出时发现局限性视网膜脱离,再次填充C3F8后视网膜复位.结论 视网膜分支静脉阻塞合并视网膜脱离的临床表现较复杂,术前眼底情况不明确,视网膜裂孔及多发性裂孔的发生率较高,多数病例玻璃体后脱离不完全粘连牵拉视网膜,且合并纤维血管膜的增生,玻璃体手术或联合手术是适合的治疗方法,可取得较好的临床疗效.