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S. Yamamoto, E. Sato, M. Kubota, A. Hoshino; angiographical changes in eyes with branch retinal vein occlusion after arteriovenous crossing sheathotomy . Invest. Ophthalmol. Vis. Sci. 2004;45(13):4569.
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© ARVO (1962-2015); The Authors (2016-present)
Purpose:To examine the angiographic and retinal thickness changes after arteriovenous (A/V) crossing sheathotomy for macular edema associated with branch retinal vein occlusion (BRVO). Methods: Adventitial sheathotomy was performed at an A/V crossing in 20 eyes of 20 patients with BRVO–associated macular edema (AS group). Simple posterior vitreous detachment was created in 16 eyes of 16 patients with BRVO–associated macular edema (PVD group). The postoperative follow–up period was more than 12 months in all cases. The best–corrected visual acuity (BCVA) in log MAR units, fluorescein angiograms (FAs), and OCT–determined foveal retinal thickness were examined preoperatively and at 12 months postoperatively. Results: The mean postoperative BCVA was 0.25 ± 0.28 log MAR units in the AS group and 0.32 ± 0.31 log MAR units in the PVD group (mean ± SD). The postoperative BCVA was significantly better than the preoperative VA in both the AS group and the PVD group (P=0.008 and P=0.001, respectively). The preoperative mean foveal retinal thickness was 626.8 ± 189.2 µm in the AS group and 559.5 ± 157.6 µm in the PVD group. Postoperatively, the foveal thickness decreased significantly 1 month after surgery in both the AS group and the PVD group (P=0.002 and P=0.007, respectively), then the thickness gradually decreased until 12 months. The differences in the mean BCVA, in the improvement of VA, and in the foveal retinal thickness between the two surgical procedures were not significant at any postoperative period. FA showed a reperfusion of the occluded vein in 10 eyes in the AS group and 2 eyes in the PVD group, and shunt vessels formation at the AV crossing site or around the macular region was observed in the other eyes in both groups. Conclusions: Both adventitial sheathotomy at an A/V crossing and the creation of a simple PVD significantly improved the macular edema associated with BRVO. However, there was no significant difference in the improvement of macular function between the two surgical procedures. The functional and morphological improvement following both surgical procedures was most likely due to the postoperative improvement of retinal circulation by the reperfusion of the occluded vein or by shunt vessel formation in all examined cases.
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