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M.L. Subramanian, J.S. Heier, T.M. Topping, A.R. Frederick, M.G. Morley; Visual Outcomes in Patients with Poor Vision from Branch Retinal Vein Occlusions . Invest. Ophthalmol. Vis. Sci. 2003;44(13):4850.
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© ARVO (1962-2015); The Authors (2016-present)
Purpose: To evaluate the visual outcome of patients with branch retinal vein occlusion (BRVO) with poor vision (20/200 or worse) from macular edema. Methods: Retrospective chart review of 143 patients diagnosed with BRVO. The visual acuity (best corrected or pinhole) was recorded at each visit. The number and timing of laser photocoagulation for macular edema was also carefully documented. Laser treatment was considered in all patients with persistent macular edema after resolution of retinal hemorrhage. Resolution of macular edema and the presence of systemic disease were also noted in all patients. Results: The charts of 143 patients who presented with a branch retinal vein occlusion from January 1981 to December 2001 were reviewed. Average age of presentation was 73.3 years, with 85 females and 58 males. Out of 143 patients, 64 had visual acuity of 20/200 or worse prior to consideration of laser therapy. Average follow-up of these 64 patients was 35.8 months (ranging from 6 to 240 months). Fifty-four of the 64 patients underwent focal or grid laser treatment for macular edema. Improvement of two lines or greater Snellen visual acuity chart was seen in 15 (28%) of 54 patients after laser, with a mean improvement of 5.0 snellen lines. Average pre-operative vision for these 15 patients was 20/364 with a mean post-operative final vision of 20/58. All 15 patients (100%) who improved with laser treatment showed complete resolution of macular edema, compared to 27 of 39 (69%) of the remaining patients treated with laser that did not show visual improvement. Ten of the 64 patients with poor vision from macular edema did not undergo laser treatment. Of those, 1 (10%) spontaneously improved by 8 snellen lines, with the remaining nine showing no improvement in vision. Only 3 (30%) of the remaining 10 had complete resolution of macular edema. Conclusions: With growing interest in innovative treatments of venous occlusive disease, such as surgical decompression or sheathotomy, careful consideration must be given as to the type of patients who may benefit from these new procedures. A vision of 20/200 is often chosen as a cutoff for eligibility for such treatments. Our study reports an improvement in 28% after laser treatment for macular edema in patients who are 20/200 or worse. This data shows that patients with poor vision from macular edema may benefit from focal or grid laser treatment, and consideration to this less invasive procedure may obviate the need for a more aggressive approach such as sheathotomy or surgical decompression.
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