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JO Mason, J Swanner, R Feist, MF White, G McGwin, TL Emond; Arteriovenous Sheathotomy To Surgically Decompress Branch Retinal Vein Occlusion: A Matched Control Study . Invest. Ophthalmol. Vis. Sci. 2002;43(13):3519.
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© ARVO (1962-2015); The Authors (2016-present)
Purpose: To assess visual outcome in patients with BRVO who underwent arteriovenous sheathotomy compared to a control group. Methods: A prospective, non-randomized comparative trial with control group was conducted in a series of patients with BRVO between April 2000 and Feb. 2001. Surgical technique included vitrectomy, posterior hyaloid removal and A-V sheathotomy using a microvitrectomy blade. 15 eyes of 15 patients with 20/70 or worse visual acuity from a BRVO underwent surgery. These patients were compared to a matched control group. The arteriole was noted to overly the venule at the BRVO site in all subjects. All patients had follow-up of 10 months or greater. Results: Average time from symptoms to surgery was 11 weeks. Surgical decompression of the A-V crossing site was achieved in all patients as defined by the separation of the arteriole from the venule. Average preoperative vision was 20/540 in the surgical group and 20/550 in the control group. 73% of the surgical group halved their visual angle at a median of 1 year after surgery compared to 33% of the control group. 40% of the surgery group had a postoperative visual acuity of 20/40 or better compared to 20% of the control group. 33% of the surgery group had a visual acuity between 20/50 and 20/70 compared to 20% of the control group. 27% of surgical eyes had postoperative vision worse than 20/200 compared to 60% of the control group. Fischer's Exact test showed no statistical significance between timing of surgery and postoperative visual acuity. There was no correlation between preoperative visual acuity and postoperative visual acuity in the surgical group using the Fischer's Exact test. Conclusion: Patients undergoing vitrectomy-BRVO sheathotomy had significantly better postoperative vision than a matched control group. The procedure is technically feasible and was accomplished without complications in our surgical group of patients. In view of this pilot study, a multi-center clinical trial is warranted to determine the efficacy of this procedure.
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