Abstract
Abstract: :
Purpose:The rate and magnitude of spontaneous visual recovery is very poor in central retinal vein occlusion (CRVO). In the first follow–up year of the Central Vein Occlusion Study Group M report, only 6% of eyes recovered > 3 lines of vision and 0% recovered > 8 lines. Retinal endovascular surgery (REVS) is a vitrectomy followed by cannulation of a branch retinal vein with injection of tissue plasminogen activator. After reports of one surgeon’s experience suggested the procedure promotes recovery of vision, other surgeons began to offer REVS to their patients. This report discusses the initial experience of 4 surgeons employing REVS to treat CRVO. Methods:In this prospective consecutive case series, patients with CRVO of > 1 week duration and acuity < 20/50 were offered REVS and were followed by the authors. The main outcome measure was recovery of visual acuity. Results:This series represents the initial 25 consecutive REVS cases of the 4 authors (5 – 7 cases per author). The median CRVO age was 2 months (mean 2.9 months), and the average pre–operative acuity was 20/400 (80% were < 20/200). Intravitreal triamcinolone acetonide (IVTA) was placed intra–operatively in 3 cases and at some time postoperatively in 6 cases. Overall, eighteen eyes (72%) recovered > 3 lines of acuity and 9 (36%) recovered > 8 lines. Among the surgeons the rates of > 3 line visual recovery ranged from 57% to 100% and the rates of > 8–line recovery ranged from 14% to 71%. Of the 22 eyes that initially had REVS without intraoperative IVTA, 13 (59%) recovered > 3 lines and 5 (23%) recovered > 8 lines. Complications included macular edema (24%), anterior segment or retinal neovascularization (24%), and subsequent cataract surgery (5 (23%) of the 22 pre–operatively phakic eyes). One eye had an intraoperative retinal detachment that was treated but recurred 4 months following REVS, and 2 of the eyes with anterior segment neovascularization developed late–onset traction retinal detachments (at 8 and 13 months following REVS). Conclusion:Although the authors were on the "learning curve" of experience during this series, REVS appears to promote visual recovery far in excess of what would be expected to occur spontaneously and IVTA greatly improved outcomes. We believe mastery of REVS techniques and the inclusion of IVTA may lead to better visual results and lower complication rates.
Keywords: vitreoretinal surgery • retina • vitreous