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J.N. Weiss, L.A. Bynoe; Retinal Endovascular Surgery for Central and Hemispheric Vein Occlusion . Invest. Ophthalmol. Vis. Sci. 2003;44(13):3033.
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Purpose: Central and hemispheric vein occlusions (CVO, HVO) are associated with intraluminal venous thrombosis and may lead to significant loss of visual acuity. Restoration of retinal perfusion is a reasonable strategy to promote visual recovery. Methods: Retinal endovascular surgery (REVS) involves vitrectomy with direct cannulation of retinal vessels. This allows the injection of tissue plasminogen activator directly into branches of the central retinal vein in order to improve retinal perfusion. The major exclusion criteria for entry into this study were visual acuity better than 20/50, active neovascular glaucoma, or evidence of severe and permanent retinal injury (such as extensive ghost vessels or marked disc pallor). Results: Of the 150 consecutive CVO cases, 51% recovered at least 3 lines of visual acuity and up to 22% recovered at least 8 lines. These rates are at least 8-fold higher than what has been shown to occur spontaneously (see table below). Of 17 eyes with HVO, 10 (59%) recovered at least 3 lines and 2 (12%) recovered at least 8 lines. Complications included macular edema (19%), vitreous hemorrhage (14%), rubeosis (8%), retinal detachment (5%), macular pucker (2%) and macular hole (<1%). Complications were more likely to occur in eyes with severe CVO preoperatively. Only one eye of the HVO group had a complication (vitreous hemorrhage). Conclusions: Despite the possibility of postoperative complications, REVS promotes visual recovery in eyes with CVO and HVO. In many cases, postoperative complications can be treated to allow further visual recovery. View OriginalDownload SlideView OriginalDownload Slide
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