Sheathotomy to decompress branch retinal vein occlusion: a matched control study.

Published on Mar 1, 2004in Ophthalmology8.47
· DOI :10.1016/J.OPHTHA.2003.05.032
John O. Mason24
Estimated H-index: 24
,
Richard M. Feist20
Estimated H-index: 20
+ 3 AuthorsTracy L. Emond9
Estimated H-index: 9
Sources
Abstract
Abstract Purpose To evaluate the efficacy and safety of arteriovenous sheathotomy surgery to decompress branch retinal vein occlusion (BRVO). Design Prospective, nonrandomized, comparative interventional trial with concurrent control group. Participants Twenty eyes with decreased visual acuity secondary to BRVO who underwent vitrectomy and surgical decompression by means of arteriovenous sheathotomy were compared with 20 control eyes (10 observation and 10 laser treated). Intervention The 20 surgical eyes underwent pars plana vitrectomy and arteriovenous sheathotomy with a microvitreoretinal blade. Of the 20 control eyes, 10 had no intervention (observation), and 10 had grid laser photocoagulation a mean of 9 months after diagnosis. Results The mean preoperative visual acuity was 20/250 in the surgical group and 20/180 in the control group (statistically similar in the observation group and laser-treated group). The mean 14-month visual acuity was 20/63 in the surgical group and 20/125 in the control group ( P = 0.02). Seventy-five percent of the surgical group halved their visual angle compared with 40% of the control group (40% observation vs. 40% laser; P = 0.025). Average lines of visual acuity gained were 4.55 in the surgical group and 1.55 in the control group ( P = 0.0226; 1.1 lines in observation group and 2.0 lines in laser group). Conclusions Surgical arteriovenous sheathotomy to decompress BRVO results in significantly better visual outcomes than a matched control group of observation and laser-treated eyes. A randomized multicenter clinical trial is warranted to determine the efficacy of this procedure.
📖 Papers frequently viewed together
156 Citations
56 Citations
107 Citations
References26
Newest
Purpose The therapeutic armamentarium for functional improvement after branch retinal vein occlusion (BRVO) is limited with uncertain efficacy. Some surgeons have proposed surgical decompression of the vein at the arteriovenous (AV) crossing. Methods Forty-three patients with BRVO were treated in the authors’ department from August 1999 to April 2001 with AV decompression. Twenty-five patients with comparable BRVO who refused this surgical intervention served as a control group. All 68 patients ...
79 CitationsSource
#1Shizuya Saika (Wakayama Medical University)H-Index: 51
#2Takeshi Tanaka (Wakayama Medical University)H-Index: 8
Last. Yoshitaka Ohnishi (Wakayama Medical University)H-Index: 30
view all 4 authors...
Purpose: To assess the effectiveness of surgical posterior vitreous detachment (PVD) together with gas/air tamponade in treating visual impairment from macular edema associated with branch retinal vein occlusion (BRVO–macular edema). Methods: A cohort study was conducted. To treat visual disturbance caused by BRVO–macular edema in 19 consecutive patients at a University Hospital, phacoemulsification, intraocular lens implantation, and vitrectomy were performed, together with gas/air tamponade. P...
100 CitationsSource
Vitreous surgery with retinal vein cannulation and injection of tissue plasminogen activator was performed in 8 eyes of 8 patients with longstanding visual loss secondary to central retinal vein occlusion. A modest improvement in visual acuity was demonstrated in 4 of the 8 eyes, and 3 of the 8 eyes maintained the preoperative vision. Retinal vein cannula-tion may offer a new treatment option for patients with central retinal vein occlusion.
33 CitationsSource
#1William M. Tang (BU: Boston University)H-Index: 4
#2Dennis P. HanH-Index: 52
Objective To develop a surgical approach to retinal vascular occlusive diseases. Methods Surgical manipulations were performed on the retinal vasculature to explore the feasibility of retinal vascular surgery. In a human cadaver eye model (25 procedures, 21 eyes), we performed (1) cannulations of retinal blood vessels with a flexible stylet and (2) arteriovenous sheathotomies. Histological findings were correlated with surgical outcomes. In an in vivo model (6 eyes, 5 animals), we examined the t...
75 CitationsSource
#1Gaurav K. Shah (Wills Eye Institute)H-Index: 32
#2Sanjay Sharma (Wills Eye Institute)H-Index: 24
Last. Gary C. Brown (Wills Eye Institute)H-Index: 40
view all 6 authors...
Abstract PURPOSE: To report arteriovenous adventitial sheathotomy for treatment of macular edema associated with branch retinal vein occlusion. METHODS: Case reports with review. Five eyes of five patients with best-corrected visual acuity of less than 20/200 secondary to branch retinal vein occlusion had pars plana vitrectomy and arteriovenous adventitial sheathotomy and were followed postoperatively for a mean of 6.5 years (range, 5 to 7 years). RESULTS: In four of five eyes, the best-correcte...
74 CitationsSource
#1Gisbert RichardH-Index: 31
Last. Hermann ZeumerH-Index: 1
view all 4 authors...
Abstract Objective Retinal arterial occlusion is one of the most dramatic problems faced by ophthalmologists because of its sudden onset and the severe consequences it may have on the visual system. In this study, local intra-arterial fibrinolysis (LIF) using recombinant tissue plasminogen activator (rTPA) as a new technique for the treatment of retinal arterial occlusion was investigated. Design Retrospective, noncomparative case series. Participants Strict inclusion and exclusion criteria were...
113 CitationsSource
#1Naoko TachiH-Index: 6
Last. Nobuchika OginoH-Index: 25
view all 3 authors...
This study was performed in order to evaluate the effect of vitrectomy in eyes with retinal vein occlusion associated with macular edema. Twenty-nine years eyes (27 patients) with branch retinal vein occlusion (BRVO), and 14 eyes (13 patients) with central retinal vein occlusion (CRVO) both associated with macular edema underwent phacoemulsification, intraocular lens implantation, pars plana vitrectomy and peeling of the posterior hyaloid membrane. Follow-up ranged from 12 to 32 months. Macular ...
106 CitationsSource
Background: Branch retinal vein occlusion (BRVO), the second most common vascular disorder of the retina, typically occurs at arteriovenous (A/V) crossings where the arteriole and venule share a common adventitial sheath. Mechanical narrowing of the venous lumen at these intersections is thought to play a pathoetiologic role in BRVO. Methods: We performed surgical decompression of BRVO via A/V crossing sheatho- tomy in 15 patients with decreased visual acuity due to macular hemorrhage, edema, an...
156 CitationsSource
#1Ian L. McAllister (Lions Eye Institute)H-Index: 38
#2John P Douglas (Lions Eye Institute)H-Index: 1
Last. Dao-Yi Yu (Lions Eye Institute)H-Index: 55
view all 4 authors...
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 u...
134 CitationsSource
#1Bimal Kumar (UWA: University of Western Australia)H-Index: 1
#2Dao-Yi Yu (UWA: University of Western Australia)H-Index: 55
Last. Ian L. McAllister (UWA: University of Western Australia)H-Index: 38
view all 6 authors...
Abstract Objective Branch retinal vein occlusions (BRVOs) are known to occur most commonly in the vicinity of arteriovenous (A/V) crossings. The authors aimed to identify types of venous wall abnormalities in BRVO and document their position in relation to the A/V crossing. Design A retrospective review of the color photographs and fluorescein angiograms from the most recent 110 patients with first- or second-order BRVO was performed. Main outcome measures The films were examined for the presenc...
80 CitationsSource
Cited By68
Newest
#1Kazuyuki KumagaiH-Index: 14
#2Nobuchika OginoH-Index: 25
Last. Mariko FurukawaH-Index: 12
view all 4 authors...
: Purpose: To determine the long-term outcomes of vitrectomy for the macular edema associated with a retinal vein occlusion (RVO). Methods: This was a retrospective, consecutive, interventional case series. The intraoperative procedures included internal limiting membrane peeling, arteriovenous sheathotomy, radial optic neurotomy, and intravitreal triamcinolone acetonide injection at the end of the surgery. The main outcome was the best-corrected visual acuity (BCVA). Results: Eight hundred and ...
1 CitationsSource
#1Kazuyuki KumagaiH-Index: 14
#2Nobuchika OginoH-Index: 25
Last. Mariko FurukawaH-Index: 12
view all 4 authors...
Purpose: The purpose of this study was to determine the long-term outcomes of intravitreal bevacizumab (IVB) or intravitreal tissue plasminogen activator (tPA) or vitrectomy for macular edema associated with a branch retinal vein occlusion (BRVO). Methods: This was a retrospective, interventional case series. Forty-one patients received a single 1.25 mg of IVB injection and followed by pro re nata protocol, 71 patients received a single intravitreal tPA, and 116 patients underwent phacovitrectom...
Source
#1Daniel D. EsmailiH-Index: 2
#2David S. Boyer (SC: University of Southern California)H-Index: 58
Retinal vein occlusions are the second most common form of retinal vascular disease. Previously, laser treatment for branch retinal vein occlusion and intravitreal triamcinolone acetonide for central retinal vein occlusion were the standard of care. Recent studies have demonstrated that anti-vascular endothelial growth factor (anti-VEGF) agents have a superior safety and efficacy profile for the treatment of both branch and central retinal vein occlusions. The use of wide-field fluorescein angio...
8 CitationsSource
#1Jia Li (UM: University of Michigan)H-Index: 3
#2Yannis M. Paulus (UM: University of Michigan)H-Index: 21
Last. Songtao Yuan (Nanjing Medical University)H-Index: 15
view all 6 authors...
For years, branch retinal vein occlusion is still a controversial disease in many aspects. An increasing amount of data is available regarding classification, pathogenesis, risk factors, natural history, and therapy of branch retinal vein occlusion. Some of the conclusions may even change our impression of branch retinal vein occlusion. It will be beneficial for our doctors to get a deeper understanding of this disease and improve the treatment skills. The aims of this review is to collect the i...
28 CitationsSource
#1Ahmet Hondur (Gazi University)H-Index: 11
#2Tongalp H. Tezel (Columbia University)H-Index: 25
Central retinal artery occlusion leads to a sudden blockage of blood supply to inner retina, resulting in severe vision loss. It is an ophthalmic emergency and widely accepted to be the ocular analogue of acute ischemic cerebral stroke. The risk factors are similar to cerebral stroke and ischemic heart disease [1].
Source
#1San Ni Chen (NCUE: National Changhua University of Education)H-Index: 5
#2Te Cheng YangH-Index: 1
Last. Iebin LianH-Index: 18
view all 4 authors...
AbstractEnd stage renal disease (ESRD) has been reported to be an important risk factor for systemic vascular disease. Retinal vein occlusion (RVO) is closely related with cardiovascular diseases; however, its association with ESRD had not been reported. The aim of the study was to investigate wheth
9 CitationsSource
#1Alan R. Berger (U of T: University of Toronto)H-Index: 14
#2Alan F. CruessH-Index: 18
Last. Eric TourvilleH-Index: 6
view all 11 authors...
Background: The availability of new therapeutic approaches, particularly intravitreal anti-vascular endothelial growth factor (anti-VEGF) therapies, has prompted significant changes to the established treatment paradigms for retinal vein occlusion (RVO). Better visual outcomes and significantly lower rates of adverse events have been noted in multiple large randomized clinical trials and have led to a new standard of care for this sight-threatening condition. Objective: To develop an expert cons...
27 CitationsSource
#1Justis P. Ehlers (Cleveland Clinic)H-Index: 32
#2Stephen J. Kim (Vandy: Vanderbilt University)H-Index: 29
Last. Sophie J. Bakri (Mayo Clinic)H-Index: 43
view all 7 authors...
Purpose To evaluate the available evidence on the ocular safety and efficacy of current therapeutic alternatives for the management of macular edema (ME) secondary to branch retinal vein occlusion (BRVO). Methods Literature searches were last conducted on January 31, 2017, in PubMed with no date restrictions and limited to articles published in English, and in the Cochrane Database without language limitations. The searches yielded 321 citations, of which 109 were reviewed in full text and 27 we...
28 CitationsSource
#1Steven Yeh (Emory University)H-Index: 33
#2Stephen J. Kim (Vandy: Vanderbilt University)H-Index: 29
Last. Jennifer E. Thorne (JHUSOM: Johns Hopkins University School of Medicine)H-Index: 68
view all 7 authors...
Purpose To review the available evidence regarding the safety and efficacy of therapies for the treatment of macular edema (ME) associated with central retinal vein occlusion (CRVO). Methods A literature search of the PubMed database was last conducted in March 2014 with no date restrictions but limited to articles published in English. A literature search of the Cochrane Library was also conducted in March 2014 with no date restrictions and without a language limitation. The combined searches y...
67 CitationsSource
#2Agnès Glacet-Bernard (University of Paris)H-Index: 23
Last. Ramin Tadayoni (University of Paris)H-Index: 43
view all 11 authors...
Resume Contexte Ces dernieres annees, les injections intravitreennes ont complete les modalites de prise en charge des œdemes maculaires (OM) secondaires a une occlusion veineuse retinienne (OVR). Cet article a pour objectif de proposer une mise a jour de la prise en charge de l’OM secondaire a une OVR. Methode Un groupe de travail s’est reuni autour de l’analyse de la litterature effectuee sur Embase/PubMed, sur les traitements des occlusions veineuses ayant une autorisation de mise sur le marc...
1 CitationsSource