Original Articles
Laser-induced chorioretinal venous anastomosis for nonischemic central retinal vein occlusion: evaluation of the complications and their risk factors

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Abstract

PURPOSE: To evaluate the complications of laser-induced chorioretinal venous anastomosis in nonischemic central retinal vein occlusion (CRVO) and to identify the associated risks.

METHODS: A retrospective consecutive series of 91 eyes (91 patients) with nonischemic CRVO with a mean ± SD duration of 15.0 ± 15.2 weeks (range, 3 to 72 weeks )and corrected visual acuity reduced to 20/100 or less because of perfused macular edema were reviewed. All eyes had one or more anastomotic attempts using argon laser (combined with Nd-YAG laser in 46 eyes) and a minimum of 12 months of follow-up.

RESULTS: Successful chorioretinal venous anastomoses were created in 49 eyes (54%). Eighteen eyes (20%) had neovascular complications. These consisted of intravitreal, intraretinal, and subretinal neovascular membranes and were significantly associated with retinal ischemia (P < .001). There was avascular fibrous tissue proliferation at the anastomotic site in eight eyes (9%), and it was not associated with retinal ischemia (P = .727). No eye developed further capillary nonperfusion once an anastomosis became functional. A chorioretinal venous anastomosis was associated with improved vision (P < .001); 84% of eyes had an average ± SD improvement of 4.3 ± 3.8 lines (range, 2 to 20 lines), with the remaining 16% having no improvement or reduced vision.

CONCLUSION: The major vision-threatening complication of laser-induced chorioretinal venous anastomosis for nonischemic CRVO is neovascular membranes occurring at the anastomotic site; these are associated with retinal ischemia. Prompt laser photocoagulation to areas of retinal ischemia that develop after the anastomotic attempt has been made may reduce the risk and severity of this complication.

Section snippets

Methods

We undertook a retrospective review of all patients with a nonischemic CRVO treated at our institution between January 1991 and July 1996 with a laser-induced chorioretinal venous anastomosis. Nonischemia was determined to be 10 disk diameters or less of capillary nonperfusion seen on a fluorescein angiogram in the area corresponding to that used by the Central Vein Occlusion Study (CVOS).6 Each eye had a visual acuity decreased to at least 20/100 or less in the involved eye because of perfused

Results

A total of 91 eyes (91 patients) with a predominantly nonischemic CRVO were treated with this technique. Sixteen eyes had some degree of retinal ischemia, ranging in size from 2 to 10 disk diameters at the time of the anastomotic attempt, as determined by capillary nonperfusion seen on 60-degree fluorescein angiograms centered on the posterior pole covering the region corresponding to the area used for grading in the CVOS.6 Ages varied from 26 to 89 years, with an average ± SD of 68.4 ± 13.6

Discussion

The concept of creating a therapeutic anastomosis between the retina and choroid as a means of treating retinal vascular occlusive disease has been raised by several authors.7, 8, 9, 10 In 1948, Verhoeff7 reported an anastomosis occurring between a retinal vessel and a choroidal vessel after treating a patient with Eales disease using diathermy. Although the potential of a therapeutically created anastomosis between the retina and the choroid in patients with retinal venous occlusive disease

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