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L.A. Bynoe; Retinal Endovascular Surgery for Hemispheric Vein Occlusion . Invest. Ophthalmol. Vis. Sci. 2005;46(13):4797.
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© ARVO (1962-2015); The Authors (2016-present)
Purpose: Retinal endovascular surgery (REVS) is a vitrectomy followed by cannulation of a branch retinal vein with injection of tissue plasminogen activator. This report discusses follow–up of patients undergoing REVS to treat eyes with hemispheric vein occlusion (HVO). Methods: In this prospective consecutive case series, 24 patients with HVO of > 1 week duration and acuity ≤ 20/63 were treated with REVS. The main outcome measure was recovery of visual acuity. Results: The mean HVO age was 3.7 months (median 3 months), the average preoperative acuity was 20/250, and 18 eyes (75%) were ≤ 20/200. Twelve HVOs (50%) involved the inferior hemiretina, 11 eyes (46%) were non–perfused or indeterminate perfusion by fluorescein angiography, and 8 eyes (33%) had the "hemi–central" congenital vascular anomaly (in which the superior and inferior main venous trunks enter the optic nerve head separately). The average postoperative follow–up was 11.4 months (range 2 – 26 months). Following REVS, the average postoperative acuity was 20/125 and only 10 (42%) were ≤ 20/200. Sixteen eyes (67%) recovered ≥ 3 lines of acuity and 8 (33%) recovered ≥ 6 lines. Of the 8 eyes with the "hemi–central" vascular anomaly, the rates of ≥ 3 and ≥ 6 line visual recovery were 62.5% and 25%, respectively. Visual recovery appeared to coincide with anatomic resolution of HVO retinopathy. Postoperative complications included macular edema (4 eyes, 17%) and vitreous hemorrhage (2 eyes, 8%). Conclusions: REVS may promote visual recovery in eyes with HVO, including those with the "hemi–central" vascular anomaly.
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