Abstract
Purpose: :
The purpose of this study is to describe the visual outcome following concomitant arteriovenous sheathotomy and intraoperative intravitreal triamcinolone acetonide (IVTA) for the treatment of branch retinal vein occlusion (BRVO). Secondary outcomes include change in central macular thickness as measured with optical coherence tomography (OCT) and venous perfusion on fluorescein angiography (FA).
Methods: :
This study is a retrospective, interventional case series study approved by the IRB of the Harkness Eye Institute at Columbia University Medical Center. Four patients were included, all with unilateral BRVO and persistent poor visual acuity who underwent 25-gauge pars plana vitrectomy, arteriovenous sheathotomy, and injection of 4mg in 0.1cc of triamcinolone acetonide. Entry criteria for treatment included best corrected visual acuity (BCVA) of less than or equal to 20/100 for four or more months despite laser treatment and/or pharmacotherapy. BCVA was recorded pre-operatively and at months 1, 3, 6, 9 and 12. OCT and FA were performed pre- and post-operatively for all patients.
Results: :
Mean logMAR acuity improved from a baseline of 20/124 to 20/122 at month 1, 20/83 at month 3 (p=NS), 20/74 at month 6 (p=NS), 20/59 at month 9 (p=0.09), and 20/47 at month 12 (p=0.007). All patients displayed an improvement in perfusion on FA and a decrease in central macular thickness on OCT.
Conclusions: :
Although arteriovenous sheathotomy or intravitreal corticosteroids have been used individually in the past to treat BRVO with reported success, the efficacy from a combined treatment modality has not been described. Intraoperative IVTA may reduce inflammation resulting from arteriovenous sheathotomy, improving retinal vein decompression in a synergistic manner. In this study, patients with BRVO recalcitrant to previous laser and/or pharmacotherapy who were treated with combined arteriovenous sheathotomy and intra-operative IVTA demonstrated statistically improved vision at one year.
Keywords: vitreoretinal surgery • corticosteroids • vascular occlusion/vascular occlusive disease