Abstract
Abstract: :
Purpose:To evaluate the efficacy of vitrectomy with complete posterior hyaloid removal and high power diode endolaser induced retinochoroidal anastomosis in the treatment of ischemic CRVO. Methods:Prospective, longitudinal, experimental and descriptive study in patients with ischemic CRVO with visual acuity (VA) of <20/100 or those whose VA decreased more than 50% during the follow-up, an area over 10 disc diameter area of nonperfused retina, and afferent pupillary defect. Eyes with rubeosis or previous laser treatment were excluded. Vitrectomy with complete posterior hyaloid removal was performed, followed by intraoperative high power (1 watt) of diode endolaser (810nm) application with the purpose of producing three or four retino-choroidal anastomosis. Rubeosis, intraocular pressure (IOP), Visual acuity and macular edema were evaluated clinically, multifocal ERG (m-ERG), fluorescein angiography (FAG) and optic coherence tomography (OCT), were performed. Follow-up was at least 6 months. Results: Five eyes were evaluated. The patients´ age ranged from 52 to 70 years, (average 59.2 years) Four (80 %) were female. 40% presented past medical history of Type 2 Diabetes Mellitus and 20% systemic arterial hypertension. Moderate improvement of visual acuity was observed in all eyes. IOP changed from 14.4 ± 1.96 mmHg to 16.8 ± 2.04 mmHg without statistical significance. Complications included fibrosis around the site of the laser delivery in 47,36%. Vitreous hemorrhage in 2 eyes, that resolved after air-fluid exchange, and exacerbation of cataract in 2 eyes, that required phacoemulsification. One eye presented rubeosis iridis after the treatment, but it was the one with longest evolution time at the moment of enrollment. Macular edema, mERG, FAG, and OCT showed improvement until the last day of follow up. Conclusion: Vitrectomy with complete posterior hyaloid following high power (1watt) diode endolaser (810nm) induced retinochoroidal anastomosis, in the treatment of ischemic central retinal vein occlusion may be useful for selected patients with isquemic CRVO. Further studies and longer follow up is needed to do general evaluation of the procedure.
Keywords: 615 vascular occlusion/vascular occlusive disease