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  • Improvement after transvitreal limited arteriovenous crossing manipulation without vitrectomy for complicated branch retinal vein occlusion using 25 gauge instrumentation

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Letter
Improvement after transvitreal limited arteriovenous crossing manipulation without vitrectomy for complicated branch retinal vein occlusion using 25 gauge instrumentation
  1. R R Lakhanpal,
  2. M Javaheri,
  3. R A Equi,
  4. M S Humayun
  1. Microsurgery Advanced Design Laboratory (MADLAB), Doheny Retina Institute, Doheny Eye Institute, Department of Ophthalmology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
  1. Correspondence to: Mark S Humayun MD, PhD, Doheny Retina Institute, Doheny Eye Institute, Department of Ophthalmology, Keck School of Medicine, University of Southern California, 1450 San Pablo Street (Room 3600), Los Angeles, CA 90033, USA; humayunusc.edu

https://doi.org/10.1136/bjo.2004.061739

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    Although arteriovenous adventitial sheathotomy (AAS) has been proposed as an alternative treatment for patients with branch retinal vein occlusion (BRVO) complicated by macular haemorrhage, persistent macular oedema after grid laser photocoagulation, and macular ischaemia, the inner retinal incision may increase the risk of retinal detachment and spontaneous vitreous haemorrhage.1–3 Han et al.2 recently proposed that incomplete separation of the common adventitial sheath without lysis may achieve comparable results. Thus, we propose transvitreal limited arteriovenous crossing manipulation (LAM) without vitrectomy as an alternative to AAS.

    Case report

    A 70 year old man with a medical history of hypertension, presented with BRVO of 14 weeks’ duration, visual acuity of 7/200, intraretinal macular haemorrhages, macular oedema assessed by ocular coherence tomography, and capillary non-perfusion on fluorescein angiography (fig 1). After informed consent and institutional review board approval was obtained, the patient underwent LAM without vitrectomy using the 25 gauge transconjunctival standard vitrectomy system (MADLAB, Bausch & Lomb, St Louis, MO, USA). Next, the blunt, flexible extendable pick (MADLAB) was introduced into the vitreous, and, once extended, makes a slit in the internal limiting membrane approximately 1.5 mm next to the pathological arteriovenous …

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