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- retinal pick
- arteriovenous adventitial sheathotomy
- branch retinal vein occlusion
- transvitreal arteriovenous- crossing manipulation without vitrectomy
- optical coherence tomography
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 …
Footnotes
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Supported in part by NIH grant for vision research EY03040 and by an unrestricted grant from Research to Prevent Blindness.
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The blunt 25 gauge nitinol flexible extendable retinal pick and the transconjunctival standard vitrectomy system (TSV) are disclosed to Bausch & Lomb Surgical, St Louis, MO, USA. The Microsurgery Advanced Design Laboratory (MADLAB) at the Doheny Retina Institute may receive royalties related to the sale of these instruments mentioned in this article to defray operating costs. The authors have no proprietary interests in any instrumentation in this article.