Elsevier

Ophthalmology

Volume 106, Issue 12, 1 December 1999, Pages 2261-2268
Ophthalmology

Fundus photographic, fluorescein angiographic, and indocyanine green angiographic signs in successful laser chorioretinal venous anastomosis for central retinal vein occlusion1

Presented in part at the American Academy of Ophthalmology annual meeting, New Orleans, Louisiana, November 1998.
https://doi.org/10.1016/S0161-6420(99)90561-4Get rights and content

Abstract

Objective

To describe the fundus signs and angiographic signs that accompany development of a laser-induced chorioretinal venous anastomosis in central retinal vein occlusion and to describe the chronology of the signs.

Design

Noncomparative, consecutive case series.

Participants

Fifteen eyes of 15 patients were treated.

Intervention

The argon laser was used in the original method of McAllister and Constable to form an anastomosis in five eyes, and the modified method of McAllister involving the argon laser followed by the YAG laser was used for ten eyes.

Main outcome measures

Changes in vessel diameters, retinal blood flow, and morphology of anastomosis over time as documented photographically and angiographically.

Results

The earliest fluorescein angiographic sign of success is a hyperfluorescent spindle at 1 week. The earliest indocyanine green angiographic sign is direct connection of retinal venous and choroidal venous circulations at 2 weeks. The earliest fundus photographic and, hence, ophthalmoscopic sign is asymmetry in venous diameter at the disc at 3 weeks. No sign is present in all successful cases. The most commonly observed sign is fluorescein flow around a corner in a retrograde direction toward the anastomosis in 80% of cases. Drainage of only a fraction of the retina occurred in 93% of cases. Fifteen eyes with successful anastomoses had mean improvement of 2.3 ± 2.4 (standard deviation [SD]) Snellen lines of best-corrected visual acuity compared to 0.2 ± 2.3 (SD) lines for 9 eyes with unsuccessful anastomoses (P = 0.0439).

Conclusion

Recognition of the variety and typical chronology of postoperative fundus and angiographic signs in laser-induced chorioretinal anastomosis will help prevent premature retreatment and guide appropriately timed additional treatment for failed initial attempts. Fluorescein angiography and indocyanine green angiography are necessary components of intensive postoperative follow-up of these patients. The follow-up care is more difficult than the technical aspects of the surgery itself. Successful anastomoses help by taking part of the flow away from the compromised central vein, not by providing global venous bypass. This technique remains controversial, unproven, and in need of a randomized clinical trial to determine its role in the management of nonischemic central retinal vein occlusion.

Section snippets

Methods

This study reports on fundus photographs, sequential fluorescein angiograms, and indocyanine green angiograms in 15 consecutive cases of successful laser-induced chorioretinal venous anastomosis for central or hemicentral retinal vein occlusion treated by 1 retina specialist in a private practice. These cases are drawn from a larger population of 24 consecutive cases treated for this condition, of which 9 were unsuccessful. The time period for case accrual was June 20, 1995, through June 9,

Results

To help in orienting the reader, results will be presented in a parallel manner for the three methods of examination: fundus photography, fluorescein angiography, and indocyanine green angiography. For each of these methods, new signs will first be described and illustrated. The relative frequency of the new and previously reported signs will be reported next. Finally, the temporal sequence of development of the signs will be reported.

Discussion

The technique of laser chorioretinal venous anastomosis has evolved since its first description in humans by McAllister and Constable in 1995.1 Prominent among the changes has been recognition of better outcomes with higher argon laser power and abandonment of sole argon use in favor of a sequential technique in which the argon laser breaks through Bruch membrane, and the YAG laser punctures the adjacent, overlying retinal vein.4 It is recognized that earlier intervention probably is favorable

References (7)

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1

The author has no proprietary interest in any of the materials used in this study.

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