Retinal Endovascular Surgery, Intravitreal Triamcinolone, and Radial Optic Neurotomy for Central Vein Occlusion

Abstract

Abstract: : Purpose:Retinal endovascular surgery (REVS), intravitreal triamcinolone acetonide injection (IVTA), and radial optic neurotomy (RON) have all been proposed as treatments for central vein occlusion (CVO). Methods:In this retrospective analysis of 150 consecutive CVO eyes receiving REVS, a subgroup of 93 eyes with preoperative acuity < 20/200 which did not receive IVTA at any time was identified for comparison to Dr. Opremcak’s series of 111 CVO eyes receiving RON. We also identified 42 CVO eyes treated with REVS and IVTA either intra–operatively or IVTA at some time during the postoperative period. Results:All subgroups demonstrated high rates of 3–line visual recovery. The rate of 3–line visual recovery was highest for the REVS/IVTA group (64%). The rates of large magnitude recovery (> 6 lines) were 2 to 3–fold higher in the REVS subgroups compared to the RON group (REVS alone – 24%, REVS/IVTA – 42%, RON – 13%; see table below). 

Conclusion:REVS and RON both appear to promote visual recovery in eyes with CVO. However, large magnitude visual recovery occurred at a higher rate in the REVS subgroups, and the rate was highest in the REVS/IVTA group. These findings suggest CVO is not a "compartment syndrome" that requires surgical optic nerve decompression to promote recovery of vision.

Keywords: vitreoretinal surgery • retina • vitreous