Radial optic neurotomy for management of hemicentral retinal vein occlusion.

OBJECTIVE: To evaluate the effect of radial optic neurotomy on visual acuity (VA) and foveal thickness in patients with hemicentral retinal vein occlusion. METHODS: A prospective noncomparative case series of 13 eyes in 13 patients with hemicentral retinal vein occlusion and a preoperative VA of 20/60 or less from a total of 232 retinal vein occlusions diagnosed. All patients underwent pars plana vitrectomy, posterior hyaloid dissection, and radial optic neurotomy at the nasal border of the optic disc. RESULTS: Visual acuity and macular thickness were measured with optical coherence tomography. Nine patients (69.2%) gained 2 or more Snellen lines of vision, and in 4 patients (30.8%) VA improved by 4 or more Snellen lines (median visual acuity, 20/50; mean VA, 20/45; P<.01) (average gain, 2.7 Snellen lines). The decrease in foveal thickness was statistically significant (P<.01) (median decrease, 297 microm). Final VA was statistically related to decreased macular thickness at optical coherence tomography (P = .03; rho = -0.62). Retinochoroidal shunts developed in 6 patients (46.1%) at the radial optic neurotomy site. No surgical complications were observed. CONCLUSIONS: Radial optic neurotomy seems to be a potential treatment in selected patients with hemicentral retinal vein occlusion, probably because of the more rapid appearance of retinochorioretinal collateral vessels, which promote faster resolution of macular edema.

Management of macular edema in branch retinal vein occlusion with sheathotomy and recombinant tissue plasminogen activator.

PURPOSE: The common adventitial sheath that surrounds the retinal venule and arteriole at the crossing site plays a crucial role in branch retinal vein occlusion (BRVO). The purpose of this study was to report the surgical recanalization of the occluded vein using a bimanual technique and recombinant tissue plasminogen activator (tPA) and its effect on final visual acuity. METHODS: Arteriovenous sheathotomy was performed, using a bimanual technique, followed by fluid-air exchange and injection of 25 mg of recombinant tPA over the area of the occluded vein. RESULTS: Intraoperative sectioning of the common arteriovenous sheath was achieved in all 40 patients. Thrombus release was observed in 11 cases (27.5%) and was correlated with early surgery (P < 0.001) and better final visual recovery (P < 0.06). Optical coherence tomography showed macular thickness that decreased by greater than 40% in 31 patients (77.5%) compared with preoperatively, and correlated to postoperative visual acuity (P < 0.001). The mean visual acuity increased from 20/100 to 20/40, with 70% of patients gaining three or more lines of visual acuity (Pearson 0.378, P = 0.016). CONCLUSION: Surgical venous decompression and injection of recombinant tPA may effectively manage macular edema secondary to BRVO, thus improving anatomic and visual outcome. Early surgical intervention may obtain maximum final visual recovery.