Radial Optic Neurotomy (RON) for Central Retinal Vein Occlusion (CRVO): Results and Complications

Abstract

Abstract: : Purpose:To review our initial experience with radial optic neurotomy (RON) for the treatment of central retinal vein occlusion (CRVO). Methods: Thirty–three patients (eyes) with central retinal vein occlusion from six institutions from Venezuela, Costa Rica, Colombia, Peru and Mexico participated in this retrospective multicenter study. Results: Preoperative visual acuity was 20/80 or worse. Mean age was 66.1 years old (35–86), and 58.8% were male. High blood pressure and diabetes was present in 64.7% and 29.4% of patients respectively. Time duration of CRVO to RON was 1–14 months (5.2). Preoperatively, the vein occlusion was perfused in 30%, nonperfused in 55%, and indeterminate in 15%. Forty percent of eyes had improvement in visual acuity, and 50% worsened at 8.2 months of follow–up. Complications occurred in 60% of cases including neovascular glaucoma in 7 (21.2%) eyes, vitreous hemorrhage in 4 (12.1%) eyes, intraoperative bleeding in 3 (9%) eyes, retinal detachment in 2 (6%) eyes, choroidovitreal neovascularization in 2 (6%) eyes, and phthisis bulbi, central retinal artery perforation, rubeosis iridis and optic atrophy in one eye (3%) each. Conclusions: Radial optic neurotomy may improve visual acuity in eyes with CRVO, although complications are common. Some results are better and cannot be explained by natural history alone. Improvement may occur because of optic nerve decompression, vitrectomy alone and/or by inducing new chorioretinal shunts that drain retinal circulation to the choroid and accelerate resolution of retinal edema. A large controlled prospective clinical trial is necessary to determine its role in the management of CRVO.

Keywords: vascular occlusion/vascular occlusive disease • vitreoretinal surgery