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J.J. Oda, J.I. Lim; Sheathotomy vs. Nonsurgical Intervention in Branch Retinal Vein Occlusions . Invest. Ophthalmol. Vis. Sci. 2005;46(13):3290.
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Purpose: To compare the outcomes of patients diagnosed with branch retinal vein occlusion who were treated with surgical intervention (pars plana vitrectomy and sheathotomy) or nonsurgical intervention (observation, focal laser, intravitreal kenalog). Methods: 21 eyes of 20 patients who had underwent surgical intervention were evaluated, and 15 eyes of 15 patients treated nonsurgically were evaluated. Eyes were evaluated for baseline visual acuity either at the preoperative visit for eyes that underwent surgical intervention or at onset of symptoms for nonsurgically treated eyes. Visual acuity was reassessed at 5–7 months and again at 10–12 months. An improvement or decline in vision was defined as a change in 3 or more lines as compared to baseline acuity. Results: Of the surgically treated eyes, 19/21 eyes were evaluated at 5–7 months and 16/21 eyes were evaluated at 10–12 months. At 5–7 months, 6/19 (32%) eyes experienced an improvement in vision, 1/19 (5%) eyes experienced a decline, and 12/19 (63%) eyes experienced no change. At 10–12 months, 6/16 (38%) eyes experienced an improvement, 3/16 (19%) eyes experienced a decline, and 7/16 (44%) eyes experienced no change. Complications observed included a visually significant epiretinal membrane (1 patient) and postoperative endophthalmitis (1 patient). Of the nonsurgically treated eyes, 15/15 eyes were evaluated at 5–7 months and 11/15 eyes were evaluated at 10–12 months. At 5–7 months, 2/15 (13%) eyes experienced an improvement, 2/15 (13%) eyes experienced a decline, and 11/15 (73%) eyes experienced no change. At 10–12 months, 4/11 (36%) eyes experienced an improvement, 0/11 (0%) eyes experienced a decline, and 7/11 (64%) eyes experienced no change. Conclusions: Sheathotomy for macular edema secondary to branch retinal vein occlusion appears to offer a improved prognosis at 5–7 months, but the benefit equalizes and there is an increased risk of visual decline at 10–12 months compared to nonsurgical intervention.
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