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A. Glacet-Bernard, J. Charbonnel, J. Korobelnik, E. Nyouma Moune, C.J. Pournaras, G. Coscas, G. Soubrane; Management of Branch Retinal Vein Occlusion with Vitrectomy and Arteriovenous Crossing Sheatotomy, the Possible Prognostic Role of Vitreous . Invest. Ophthalmol. Vis. Sci. 2003;44(13):4063.
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Purpose: To assess the feasibility and the effectiveness of vitrectomy and adventitial sheatotomy in the management of retinal branch vein occlusion (RVO), and to analyze the prognostic role of initial data in the postoperative outcome, in particular the role of previous posterior vitreous detachment (PVD). Methods: Twelve RVO eyes with progressive decrease in visual acuity were operated on in 2 centers. Mean age of patients was 66 years, 4 were male. RVO involved the superotemporal quadrant in 6 eyes, peripheral ischemia was present in 8 eyes and all had macular edema. Surgical procedure included a 3-port pars plana vitrectomy (with posterior hyaloid detachment in eyes with no previous PVD), removal of the internal limiting membrane and arteriovenous crossing sheatotomy. Clinical evaluation was based on best-corrected visual acuity, fluorescein angiography and optical coherence tomography. Results: An improvement in visual acuity was observed in 8 eyes (66%). Mean gain was 1.2 ETDRS lines. The comparison between eyes with improvement and eyes without improvement showed no difference for age, duration of the RVO, and for the location of the occlusion. Absence of previous PVD, poor initial visual acuity and presence of retinal ischemia were correlated to the improvement in vision (p=0.004, p=.002, and p=.024 respectively). Eyes with initial PVD had postoperatively a mean loss of –5.7 ETDRS lines and eyes without PVD had a gain of 3.7 lines. Conclusions: Vitrectomy with sheatotomy seems to be of benefit in the management of BVO, particularly in eyes with no previous PVD. The role of vitrectomy could be as important (or more) as the action of dissecting of arteriovenous crossing. Further studies are needed to evaluate the distinct role of vitrectomy and of sheatotomy in BVO in order to select the most efficient surgical management.
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