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R.R. Lakhanpal, M. Javaheri, A.C. Barnes, E. de Juan, Jr, M.S. Humayun; Vitrectomyless Limited Sheath: Manipulation using 25–gauge Instrumentation: For Complicated Branch Retinal Vein Occlusion . Invest. Ophthalmol. Vis. Sci. 2004;45(13):4568.
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Purpose: To evaluate the outcomes of a new technique, 25–gauge vitrectomyless limited sheath manipulation and intraoperative reperfusion visualization, for the treatment of branch retinal vein occlusion complicated by macular hemorrhage, macular ischemia, and/or macular edema recalcitrant to grid laser photocoagulation. Methods: A consecutive, retrospective, interventional case series of sixteen eyes of 15 patients from May 2001 to June 2003 was undertaken. All eyes underwent vitrectomyless limited sheath manipulation performed by a single surgeon (MSH) using the 25–gauge nitinol flexible–extendable blunt pick. Four eyes (25%) with angiographic evidence of extensive preoperative macular edema and/or ischemia underwent concomitant intravitreal steroid injection. Main outcome measures included presence or absence of intraoperative reperfusion visualization, pre– and postoperative visual acuity, macular thickness as measured by optical coherence tomography, intraocular pressure, and lens status. Results: Intraoperative vascular reperfusion was visualized in all eyes. Mean visual acuity improved from 20/200 (Log MAR 1.03 +/– 0.32) preoperatively to 20/60 (0.50 +/– 0.28) (p<0.0001) at final visit. Fifteen of 16 eyes (94%) experienced visual improvement. Thirteen of 16 eyes (81%) experienced two or more lines of visual improvement. Eight eyes (50%) exhibited final acuity of 20/50 or better. Mean macular thickness improved from 419.6 +/– 95.2 µm to 180.1 +/– 42.4 µm (p<0.0001) at final visit. No statistically significant difference was noted in cataract progression or intraocular pressure between the steroid and non–steroid groups. Mean follow–up was 43.4 +/– 20.5 weeks. All patients were followed for at least twelve weeks. Conclusions: Vitrectomyless limited sheath manipulation, with or without intravitreal steroids, may achieve comparable outcomes to arteriovenous adventitial sheathotomy for complicated branch retinal vein occlusion. A prospective, randomized trial is warranted.
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