Evaluation of arteriovenous crossing sheathotomy for branch retinal vein occlusion by fluorescein videoangiography and image analysis

doi:10.1016/j.ajo.2003.11.071

American Journal of Ophthalmology

Volume 137, Issue 5, May 2004, Pages 834-841

https://doi.org/10.1016/j.ajo.2003.11.071 Get rights and content

Abstract

Purpose

We quantitatively evaluated the effects of arteriovenous (A/V) crossing sheathotomy on retinal circulation in patients with branch retinal vein occlusion (BRVO) accompanied by macular edema.

Design

Interventional case series.

Methods

In 18 consecutive patients (18 eyes) with BRVO accompanied by macular edema who underwent A/V crossing sheathotomy between August 1999 and April 2002, changes in retinal circulation after the surgery were evaluated by fluorescein videoangiography with a scanning laser ophthalmoscope and by image analysis using dye dilution technique. At a venule distal to the responsible A/V crossing site and a normal venule, the circulation time (T50) from the beginning of filling to 50% filling of the peak intensity was calculated. The time difference (ΔT50) between T50 at the point on the affected venule and that at the point on the normal venule, which represents the filling delay at the venule distal to the A/V crossing site, was compared between before and early after the surgery.

Results

The preoperative ΔT50 was 1.36 ± 1.15 seconds (mean ± SD), and the postoperative ΔT50 was 0.72 ± 0.77 seconds (P = .035, paired t test). In 11 of the 18 eyes, ΔT50 decreased by 20% or more after the surgery. In the other 7 eyes, ΔT50 was unchanged or slightly increased after the surgery.

Conclusions

Although a randomized controlled study is needed to confirm the effectiveness of A/V crossing sheathotomy on visual function, this technique could be effective for improving the delay in perfusion in the affected venule.

Section snippets

Methods

The subjects were 18 consecutive patients (18 eyes) consisting of seven males and 11 females with BRVO accompanied by macular edema who underwent vitreous surgery with A/V crossing sheathotomy at the Okayama University Hospital between August 1999 and April 2002. All patients enrolled gave informed consent. The 18 eyes met the following criteria: 1) presence of blood flow (including backflow) observed in venules proximal to the A/V crossing site by preoperative fluorescein videoangiography, 2)

Results

The data on all eyes are shown in Table 1.

The duration from the onset of visual impairment due to BRVO to surgery was 2 to 9 months (mean, 4.2 months). Posterior vitreous detachment was already present before the operation in two eyes. In all eyes, the arteriole could be separated from the venule at the responsible A/V crossing site. In one eye, hemorrhage due to retinal vascular damage was observed during A/V crossing sheathotomy but could be immediately stopped by high perfusion pressure. No

Discussion

Vitrectomy alone could be effective for resolution of macular edema and hemorrhage and for improvement in visual acuity.10, 11, 12 Unless A/V crossing sheathotomy can improve delay in venular perfusion, it has no additional values and does not differ from vitrectomy alone. The present study was performed to confirm effects of A/V crossing sheathotomy on affected retinal circulation, and the results obtained showed improvement in the perfusion in the affected venule early after the surgery.

Supplementary files

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Evaluation of arteriovenous crossing sheathotomy for branch retinal vein occlusion by fluorescein videoangiography and image analysis☆

Abstract

Purpose

Design

Methods

Results

Conclusions

Section snippets

Methods

Results

Discussion

Supplementary files

Am J Ophthalmol

Surgical decompression of branch retinal vein occlusion via arteriovenous crossing sheathotomyA prospective review of 15 cases

Retina

Argon laser photocoagulation for macular edema in branch vein occlusion

Am J Ophthalmol

Argon laser photocoagulation for macular edema in branch vein occlusion

Am J Ophthalmol

Measurements of retinal microcirculation in retinal vessel occlusion before and after treatment

Graefes Arch Clin Exp Ophthalmol

Effect of vitrectomy for macular edema secondary to branch retinal vein occlusion

Ganka Shujutu (J Jpn Soc Ophthalmic Surg)