Abstract
Background
To analyze the results of vitrectomy and adventitial sheathotomy in the management of branch retinal vein occlusion (BRVO). This is a nonrandomized interventional case series.
Methods
Patients with BRVO with progressive decrease in visual acuity underwent surgery and were prospectively evaluated in two centers. Surgical procedure included a 3-port pars plana vitrectomy, removal of the internal limiting membrane and arteriovenous crossing sheathotomy. Clinical evaluation consisted of best-corrected visual acuity, fluorescein angiography and optical coherence tomography.
Results
Thirteen eyes were analyzed consecutively. An improvement in visual acuity of two ETDRS lines or more was observed in nine eyes (69%). The mean gain was 1.9 ETDRS lines. The absence of previous posterior vitreous detachment (PVD), poor initial visual acuity and the presence of retinal ischemia were correlated to the improvement in vision (P=0.014, P=0.002 and P=0.052, respectively). Eyes with initial PVD had a mean loss postoperatively of −5.7 lines, but eyes without PVD experienced a gain of 4.2 lines (P<0.001). Macular edema decreased significantly (preoperative thickness: 714 µm, postoperative thickness: 353 µm, P=0.04), whereas the aspect of the vein at the crossing and the non-perfused area remained unchanged.
Conclusion
Vitrectomy with sheathotomy seems to be of benefit in the management of BRVO, particularly in eyes with no previous PVD, and the main postoperative feature was the decrease in macular edema. The surgical detachment of posterior hyaloid could be as important (or more) as the sheathotomy itself. Further studies are needed to define the most efficient surgical management of BRVO.
Similar content being viewed by others
References
Avunduk AM, Cetinkaya K, Kapicioglu Z, et al (1997) The effect of posterior vitreous detachment on the prognosis of branch retinal vein occlusion. Acta Ophthalmol Scand 75:441–442
Branch Vein Occlusion Study Group (1984) Argon laser photocoagulation for macular edema in branch vein occlusion. Am J Ophthalmol 98:271–282
Branch Vein Occlusion Study Group (1986) Argon laser scatter photocoagulation for prevention of neovascularization and vitreous hemorrhage in branch vein occlusion. A randomized clinical trial. Arch Ophthalmol 104:34–41
Chen HC, Wiek J, Gupta A, et al. (1998) Effect of isovolaemic haemodilution on visual outcome in branch retinal vein occlusion. Br J Ophthalmol 82:162–167
Finkelstein D (1992) Ischemic macular edema. Recognition and favorable natural history in branch vein occlusion. Arch Ophthalmol 110:1427–1434
Finkelstein D (1999) Branch retinal vein occlusion. In: Guyer DR (ed) Retina, vitreous, macula, 1st edn. WB Saunders, Philadelphia, pp 308–315
Glacet-Bernard A, Coscas G, Chabanel A, et al (1994) A randomized, double-masked study on the treatment of retinal vein occlusion with troxerutin. Am J Ophthalmol 118:421–429
Glacet-Bernard A, Coscas G, Chabanel A, et al (1996) Prognostic factors for retinal vein occlusion: prospective study of 175 cases. Ophthalmology 103:551–560
Hikichi T, Konno S, Trempe CL (1995) Role of the vitreous in central retinal vein occlusion. Retina 15:29–33
Le Rouïc JF, Bejjani RA, Rumen F, et al (2001) Adventitial sheathotomy for decompression of recent onset branch retinal vein occlusion. Graefes Arch Clin Exp Ophthalmol. 239:747–751
Mester U, Dillinger P (2002) Vitrectomy with arteriovenous decompression and internal limiting membrane dissection in branch retinal vein occlusion. Retina 22:740–746
Mitchell P, Smith W, Chang A (1996) Prevalence and associations of retinal vein occlusion in Australia. The Blue Mountains Eye Study. Arch Ophthalmol 114:1243–1247
Opremcak EM, Bruce RA (1999) Surgical decompression of branch retinal vein occlusion via arteriovenous crossing sheathotomy: a prospective review of 15 cases. Retina 19:1–5
Osterloh MD, Charles S (1988) Surgical decompression of branch retinal vein occlusions. Arch Ophthalmol 106:1469–1471
Saika S, Tanaka T, Miyamoto T, et al (2001) Surgical posterior vitreous detachment combined with gas/air tamponade for treating macular edema associated with branch retinal vein occlusion: retinal tomography and visual outcome. Graefes Arch Clin Exp Ophthalmol 239:729–732
Scott IU (2002) Vitreoretinal surgery for complications of branch retinal vein occlusion. Curr Opin Ophthalmol 13:161–166
Sekiryu T, Yamauchi T, Enaida H, et al (2000) Retina tomography after vitrectomy for macular edema of central retinal vein occlusion. Ophthalmic Surg Lasers 31:198–202
Shah GK, Sharina S, Fineman MS, et al (2000) Arteriovenous adventitial sheathotomy for the treatment of macular edema associated with branch retinal vein occlusion. Am J Ophthalmol 129:104–106
Stefansson E (2001) The therapeutic effects of retinal laser treatment and vitrectomy. A theory based on oxygen and vascular physiology. Acta Ophthalmol Scand, 79:435–440
Stefansson E, Novack RL, Hatchell DL (1990) Vitrectomy prevents retinal hypoxia in branch retinal vein occlusion. Invest Ophthalmol Vis Sci 31:284–249
Tachi N, Hashimoto Y, Ogino N (1999) Vitrectomy for macular edema combined with retinal vein occlusion. Doc Ophthalmol 97:465–469
Tang WM, Han DP (2000) A study of surgical approaches to retinal vascular occlusions. Arch Ophthalmol. 118:138–143
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Charbonnel, J., Glacet-Bernard, A., Korobelnik, JF. et al. Management of branch retinal vein occlusion with vitrectomy and arteriovenous adventitial sheathotomy, the possible role of surgical posterior vitreous detachment. Graefe's Arch Clin Exp Ophthalmol 242, 223–228 (2004). https://doi.org/10.1007/s00417-003-0824-4
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00417-003-0824-4