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J. Guerrero, L. Suarez-Tata, C. Leizaola-Fernandez, J. Jimenez-Sierra, H. Quiroz-Mercado; Efficacy of Vitrectomy with Complete Posterior Hyaloid Remove in the Treatment of Ischemic Central Retinal Vein Occlusion (CRVO) . Invest. Ophthalmol. Vis. Sci. 2003;44(13):4065.
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© ARVO (1962-2015); The Authors (2016-present)
Purpose: Pars plana vitrectomy (PPV) along with other maneuvers have been reported useful for eyes with ischemic central retinal vein occlusion (CRVO) like: radial optic neurotomy, retinochoroidal anastomosis and retinal endovascular surgery. As PPV was performed en all techniques we evaluated a solo vitrectomy with posterior hyaloid removal in ischemic central retinal vein occlusion (a control group study). Methods: Prospective, longitudinal, experimental and descriptive study in patients with ischemic CRVO with visual acuity (VA) <20/100 or those whose VA decreased more than 50% during the follow-up, an area over 10 disc diameter of nonperfused retina, and afferent pupillary defect. Eyes with rubeosis or previous laser treatment were excluded. All patients underwent vitrectomy with complete posterior hyaloid removal. Rubeosis, intraocular pressure (IOP), visual acuity and macular edema were evaluated clinically, multifocal ERG (m-ERG), fluorescein angiography (FA) and optic coherence tomography (OCT), were also performed. Follow-up was at least 6 months Results: Seven eyes were evaluated. Age ranged from 57 to 74 years, (average 66.14 years). Five (71.43%) were male. 57.14% presented past medical history of Type 2 Diabetes Mellitus and 42,86% systemic arterial hypertension. Moderate improvement of visual acuity was observed in 57.14% eyes and stabilized in 42.86%. IOP changed from 14.42 ± 2.7 mmHg to 13.86 ± 2.48 mmHg post-operative. One eye presented rubeosis iridis 6 months after the treatment and vitreous hemorrhage that resolved after air-fluid exchange and panretinal photocoagulation. Macular edema was evaluated with OCT: Pre-operative average was 1012 ± 158 mm; first month post-operative was 767 ± 290 mm and third months 652 ± 275 mm with stadistical diference between each group (p= 0.002) Friedman study. Between basal group and first month (p= 0.028). Between basal and 3er months (p= 0.018) Wilcoxon Signed Ranks Test. Macular edema, mERG, FA, and OCT showed improvement until the last day of follow up. Conclusions: A solo PPV with posterior hyaloid removal may help to improve anatomic anad functional retina conditions in some cases. This results should be considered when analizing other surgical maneuvers.
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