Purchase this article with an account.
A.K. Lauer, C.K. Richard, J.E. Robertson, Jr, L.E. Viegland, D. Martin; JUXTAPAPILLARY OR EPIPAPILLARY RETINOCHOROIDAL ANASTAMOSIS IS A FEATURE OF RADIAL OPTIC NEUROTOMY IN CENTRAL RETINAL VEIN OCCLUSION. . Invest. Ophthalmol. Vis. Sci. 2004;45(13):5261.
Download citation file:
© ARVO (1962-2015); The Authors (2016-present)
Purpose:To describe novel features of this emerging procedure for the treatment of central retinal vein occlusion (CRVO) Methods:Patients with severe CRVO (ETDRS visual acuity < 20/200) enrolled in an institution approved non–randomized prospective interventional trial underwent transvitreal radial optic neurotomy. The incision of the scleral ring and lamina cribosa was made at the nasal optic disc. Standardized visual acuity, fundus photography, fluorescein angiography and optical coherence tomography were conducted preoperatively and at specified intervals postoperatively. The fluorescein angiographic studies were reviewed. Results:Between the first and third postoperative month, four of six patients (66.6%) who underwent radial optic neurotomy developed epipapillary or juxtapapillary formation of new moderate caliber vessels at the radial incision site. These vessels hyperfluoresce during the venous phase of the fluorescein angiogram and do not leak in the angiographic late phases, suggesting that these are anastamotic shunt or collateral vessels rather incompetent vessels as seen in choroidal neovascularization. In the other two patients, the presence of these vessels in the first and third postoperative month could not be appreciated due to juxtapapillary subretinal hemorrhage from the incision in one patient and juxtapapillary retina due to central retinal vein occlusion in the other patient. Conclusions:Radial optic neurotomy has been proposed to relieve a compartment syndrome induced by the swelling of the optic nerve head induced in central retinal vein occlusion. Although this may indeed be the case initially, the development of new epipapillary or juxtapapillary anastamotic vessels may also influence retinal venous outflow in these patients. Further investigation will be necessary in this ongoing trial.
This PDF is available to Subscribers Only