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H Quiroz-Mercado, MS Blumenkranz, DV Palanker, SR Sanislo, G Garcia-Aguirre, R Magdalenic, CE Araya-Munoz, M Ruiz; Surgical Therapy of Central Retinal Vein Occlusion by Creation of Choroidal Retinal Anastomosis . Invest. Ophthalmol. Vis. Sci. 2002;43(13):1872.
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© ARVO (1962-2015); The Authors (2016-present)
Purpose: So far, there are no accepted treatments for the early phase of central retinal vein occlusion (CRVO). However, vitrectomy and induction of retino-choroidal anastomosis (RCA) with Er:Yag laser for this purpose has been reported previously (IOVS 2000;41(4):B523 Abs nr 3425). Our purpose was to evaluate the safety and potential efficacy of surgical creation of a RCA by different surgical methods in patients with CRVO. Methods: Patients age 18 to 85 with the clinical diagnosis of non-ischemic CRVO, who provided informed consent, were included. Patients with visual acuity of less than 20/400 in the fellow eye or visual acuity in the study eye greater than 20/200 or less than light perception were not eligible for inclusion. Patients underwent complete preoperative and postoperative ophthalmic evaluation as well as standardized data collection. Patients underwent vitrectomy with separation of posterior hyaloid followed by induction of one or several RCA. This was achieved by using either Er:YAG laser, or the Pulsed Electron Avalanche Knife (PEAK). This was performed adjacent to a major branch venule 2 to 3 disc diameters away from the optic nerve or macular area, generally nasally. The presence of a successful RCA was determined by fluorescein angiography six weeks following the surgical procedure. A total of 11 patients were studied; nine with Er:YAG laser, and two with the PEAK device. Results: Overall, the success rate for creation of functioning RCA was 18.1%. This included 11.1% of those with the Er:YAG, and 50% of those with the PEAK device. Compared with the Er:YAG laser, the PEAK demonstrated less tissue ejection, fewer gas bubbles, and convenient endo illumination allowing for bimanual surgical maneuvers including aspiration of blood associated with the procedure. One of the patients treated with the PEAK developed mild vitreous hemorrhage postoperatively which was successfully treated by postoperative fluid-air exchange. Three of the patients treated with Er:YAG developed neovascular glaucoma, treated with panretinal photocoagulation and antiglaucomatous drugs in two patients and with a valvular implant in one patient. Conclusion: Surgical treatment of CRVO by the creation of a RCA may be an effective therapy for some patients with CRVO. There appeared to be specific advantages and disadvantages associated with different instrumentation employed to create these anastomosis.
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