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E. Opremcak, K. R. Baxter; Restoration of Retinal Blood Flow in Branch Retinal Vein Occlusion via Arteriovenous Crossing Sheathotomy and Adjunctive Pneumatic Fluid Displacement. Invest. Ophthalmol. Vis. Sci. 2010;51(13):1766.
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© ARVO (1962-2015); The Authors (2016-present)
Branch retinal vein occlusion (BRVO) is the second most common vascular disorder of the retina, resulting in retinal hemorrhage, edema, and ischemia.¹ The location of the vein occlusion and the length of time it has been occluded greatly affects visual acuity and visual prognosis in patients with this common retinal vascular disorder. BRVO occurs at arteriovenous (A/V) crossings where the arteriole and venule share a common adventitial sheath. ¹ The blockage of the vessel results in an increase in backpressure due to inhibition of normal blood flow, resulting in the associated signs and symptoms. Restoration of retinal blood flow in branch retinal vein occlusion via arteriovenous crossing sheathotomy and adjunctive pneumatic fluid displacement was performed and compared to ascertain any anatomic or visual benefit.
Surgical decompression of BRVO via A/V crossing sheathotomy with pneumatic fluid displacement and without pneumatic fluid displacement was performed in 38 patients with decreased visual acuity due to intraretinal hemorrhage, edema and ischemia.
Intraoperative decompression of the A/V crossing was achieved in all 38 patients. All patients showed clinical improvement as determined by fundus examination, photography, and fluorescein angiography. In 29/39 patients A/V sheathotomy was performed with pneumatic fluid displacement and 86% of these patients had equal or better postoperative visual acuity with an average gain of 4 lines of vision. Additionally, 9/39 patients underwent A/V sheathotomy without pneumatic fluid displacement and 89% experienced an increased postoperative visual acuity with an average gain of 5 lines of vision. Overall, twenty-five of the 38 total subjects (64%) had improved visual acuity with an average gain of 4 lines of vision.
Re-establishing retinal blood flow through A/V crossing sheathotomy has been proven to be successful in reperfusing the retina. Placement of pneumatic fluid intraoperatively may aid in decreasing retinal hemorrhage and edema more rapidly resulting in a better visual outcome.
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