Arteriovenous adventitial sheathotomy for the treatment of macular edema associated with branch retinal vein occlusion

doi:10.1016/S0002-9394(99)00287-1

American Journal of Ophthalmology

Volume 129, Issue 1, January 2000, Pages 104-106

Data from this work were presented in part at the Annual Meeting for Research in Vision and Ophthalmology, Fort Lauderdale, Florida, May 10, 1998.

https://doi.org/10.1016/S0002-9394(99)00287-1 Get rights and content

Abstract

PURPOSE: To report arteriovenous adventitial sheathotomy for treatment of macular edema associated with branch retinal vein occlusion.

METHODS: Case reports with review. Five eyes of five patients with best-corrected visual acuity of less than 20/200 secondary to branch retinal vein occlusion had pars plana vitrectomy and arteriovenous adventitial sheathotomy and were followed postoperatively for a mean of 6.5 years (range, 5 to 7 years).

RESULTS: In four of five eyes, the best-corrected visual acuity improved to 20/30 to 20/70. In the remaining eye, visual acuity remained at finger counting secondary to macular ischemia.

CONCLUSION: Arteriovenous adventitial sheathotomy may be beneficial for select patients with poor vision secondary to branch retinal vein occlusion.

References (3)

Argon laser photocoagulation for macular edema in branch vein occlusion
Am J Ophthalmol
(1984)

There are more references available in the full text version of this article.

Cited by (78)

Morphologic and Functional Retinal Vessel Changes in Branch Retinal Vein Occlusion: An Optical Coherence Tomography Angiography Study
2017, American Journal of Ophthalmology
The present study aimed to investigate the morphology of the retinal vasculature in eyes with branch retinal vein occlusion (BRVO) using optical coherence tomography (OCT) angiography.
Observational case series.
Fluorescein angiography (FA) and OCT angiography were used to examine macular area and the retinal vasculature at the affected arteriovenous (AV) crossing in 46 patients with BRVO.
FA revealed that the affected AV crossing pattern involved arterial overcrossing in 23 eyes (50.0%) and venous overcrossing in 11 eyes (23.9%). However, FA failed to detect the crossing pattern in 10 eyes (21.7%). OCT angiography was significantly more effective for identification of the AV crossing pattern than FA (44 eyes; 95.7%; P = .013). The number of eyes with venous overcrossing detected via OCT angiography (20 eyes, 43.5%) was also higher than that detected via FA (P = .047). OCT angiography revealed that venous narrowing (25.5 ± 21.1 μm) was significantly greater in instances of venous overcrossing than in those of arterial overcrossing (46.4 ± 23.7 μm, P = .005). Macular nonperfusion areas (NPAs) were larger in eyes with venous overcrossing than in those with arterial overcrossing (P = .011 for superficial plexus, P = .049 for deep plexus). The peripheral NPA was significantly larger in eyes with venous overcrossing (65.1 ± 35.3 disc area [DA]) than in those with arterial overcrossing (17.2 ± 24.1 DA; P < .001).
Our findings suggest that BRVO characterized by venous overcrossing may be more prevalent than previously reported, and that there is a significant association between NPA size and AV crossing pattern.
Intravitreal Aflibercept for Macular Edema Following Branch Retinal Vein Occlusion 52-Week Results of the VIBRANT Study
2016, Ophthalmology
To determine week 52 efficacy and safety outcomes in eyes with macular edema after branch retinal vein occlusion (BRVO) treated with 2 mg intravitreal aflibercept injection (IAI) compared with grid laser.
VIBRANT was a double-masked, randomized, phase 3 trial.
Eyes randomized and treated in VIBRANT were followed to week 52.
In the IAI group, eyes received IAI every 4 weeks through week 24 and IAI every 8 weeks through week 48 with rescue grid laser if needed at week 36. In the grid laser group, all eyes received grid laser at baseline and, if prespecified rescue criteria were met, 1 additional laser from week 12 to 20 and IAI every 8 weeks after 3 monthly doses from week 24 onward (the laser/IAI group).
The primary outcome measure was percentage of eyes with improvement from baseline best-corrected visual acuity (BCVA) letter score ≥15 at week 24. All outcome measures at week 52 were exploratory, and P values are considered nominal.
The percentage of eyes with improvement from baseline letter score ≥15 in the IAI and laser/IAI groups was 52.7% versus 26.7% (P = 0.0003) at week 24 and 57.1% versus 41.1% (P = 0.0296) at week 52. The corresponding mean change from baseline BCVA letter score was 17.0 versus 6.9 (P < 0.0001) at week 24 and 17.1 versus 12.2 (P = 0.0035) at week 52. The mean reduction from baseline central retinal thickness was 280.5 μm versus 128.0 μm (P < 0.0001) at week 24 and 283.9 μm versus 249.3 μm (P = 0.0218) at week 52. In the IAI group, 10.6% of eyes received rescue laser at week 36, and in the laser/IAI group, 80.7% received rescue IAI from week 24 to week 48. Traumatic cataract in 1 eye (1.1%) in the IAI group was the only ocular serious adverse event.
After 6 monthly IAI, injections every 8 weeks maintained control of macular edema and visual benefits through week 52. In the laser group, rescue IAI given from week 24 onward resulted in substantial visual improvements at week 52.
Management of macular edema secondary to retinal vein occlusion
2015, Journal Francais d'Ophtalmologie
Ces dernières années, les injections intravitréennes ont complété les modalités de prise en charge des œdèmes maculaires (OM) secondaires à une occlusion veineuse rétinienne (OVR). Cet article a pour objectif de proposer une mise à jour de la prise en charge de l’OM secondaire à une OVR.
Un groupe de travail s’est réuni autour de l’analyse de la littérature effectuée sur Embase/PubMed, sur les traitements des occlusions veineuses ayant une autorisation de mise sur le marché et remboursés sur le territoire français. Au total, 33 articles ont été retenus. Un consensus au sein du groupe pour des recommandations basées sur ces données de la littérature et leurs expériences cliniques a été trouvé et rapporté dans cet article.
La prise en charge de l’OM secondaire à une occlusion de branche veineuse rétinienne (OBVR) ou à une occlusion de veine centrale de la rétine (OVCR) diffère sur un certain nombre de points. Des modalités de bonnes pratiques de prise en charge ont ainsi été discutées, séparément dans les OBVR et les OVCR, en prenant en compte différents paramètres oculaires ou associés.
Le ranibizumab et l’implant de dexaméthasone sont des traitements de première intention de la baisse visuelle due à l’OM secondaire à une OVR. Le choix de l’un ou l’autre de ces médicaments peut se faire en tenant compte de différents paramètres oculaires mais aussi extra-oculaires. Un changement de traitement vers l’un ou l’autre ou vers le laser peut aussi être envisagé durant le suivi.
In recent years, intravitreal injections have added to the treatment modalities available for macular edema (ME) secondary to retinal vein occlusion (RVO). This article aims to provide an update regarding the management of ME secondary to RVO.
A work group met in order to analyze the literature available on Embase/PubMed, regarding treatments for venous occlusion that have received market approval and are reimbursed in France. In total, 33 articles were selected. Consensus within the group for recommendations was based on this data from the literature review and clinical experience and was reported in this article.
The management of ME secondary to branch retinal vein occlusion (BRVO) or central vein occlusion of the retina (CRVO) differs on a number of points. Methods of best practice were discussed separately for BRVO and CRVO, taking into account various ocular and associated parameters.
Ranibizumab and dexamethasone implant are the first-line treatments for visual impairment due to ME secondary to RVO. The choice of either of these drugs may take into account various ocular and extraocular parameters. A change of treatment to one or the other or to laser may also be considered during follow-up.
Retinal vein occlusion: Beyond the acute event
2011, Survey of Ophthalmology
Citation Excerpt :
Arteriovenous sheathotomy, in which the retinal vein and artery are surgically separated at the arteriovenous crossing by cutting the common adventitial sheath, has generally had no beneficial effect on visual acuity.17,80 However, several case series as well as a nonrandomized controlled study have demonstrated improved CME and/or visual acuity.86,90,99,119 Pilot studies have suggested that pars plana vitrectomy (PPV) with removal of the posterior hyaloid, but no sheathotomy, may lead to resolution of CME secondary to BRVO.3,116,126
Retinal vein occlusion is a major cause of vision loss. We provide an overview of the clinical features, pathogenesis, natural history, and management of both branch retinal vein occlusion and central retinal vein occlusion. Several recent multicenter randomized clinical trials have been completed which have changed the approach to this disorder. Management of retinal vein occlusions can be directed at the underlying etiology or the resulting sequelae. Options include surgical intervention, laser photocoagulation, intravitreal pharmacotherapy, and sustained drug delivery devices.
Internal Limiting Membrane Peeling in Vitreo-retinal Surgery
2008, Survey of Ophthalmology
Citation Excerpt :
The only proven treatment for macular edema related to BRVO through an RCT is laser photocoagulation.1 Several studies have reported good results following surgical decompression of the occluded vein by means of arteriovenous crossing sheathotomy, with restoration of retinal blood perfusion and visual improvement in cases of severe edema, hemorrhage, or ischemia.13,41,282,283,324 ILM peeling over the arteriovenous crossing is an integral part of sheathotomy.
Peeling the internal limiting membrane of the retina has become a very common procedure performed by vitreo-retinal surgeons. The combination of new microsurgical instrumentation with the availability of different dyes to stain this thin and transparent membrane has facilitated the performance of internal limiting membrane peeling, reducing the time and trauma associated with this maneuver. Internal limiting membrane peeling has been used to treat a variety of retinal pathologies, including full-thickness macular hole, epiretinal membrane, macular edema, vitreomacular traction syndrome, and Terson syndrome, among others. Although it appears that peeling the internal limiting membrane in these retinal conditions may be associated with better anatomical and visual outcomes following surgery, further evidence through randomized controlled clinical trials is still needed to guide the vitreo-retinal surgeon on the appropriate use of this surgical maneuver.
Retinal arterial and vein occlusion: is surgery ever indicated?
2024, Current Opinion in Ophthalmology

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^☆: This work was supported by the Heed Ophthalmic Foundation, Cleveland, Ohio (G.K.S.), the Vitreo-Retinal Research Fund, Philadelphia, Pennsylvania (G.K.S., S.S., M.S.F.), and the EA Baker Foundation, Toronto, Canada (S.S.).

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Brief ReportsArteriovenous adventitial sheathotomy for the treatment of macular edema associated with branch retinal vein occlusion☆

Abstract

Argon laser photocoagulation for macular edema in branch vein occlusion

Am J Ophthalmol

Brief Reports
Arteriovenous adventitial sheathotomy for the treatment of macular edema associated with branch retinal vein occlusion☆