Arteriovenous sheathotomy for persistent macular edema in branch retinal vein occlusion.

Published on Dec 1, 2006in Korean Journal of Ophthalmology
· DOI :10.3341/KJO.2006.20.4.210
Joon Hong Sohn1
Estimated H-index: 1
Su Jeong Song6
Estimated H-index: 6
(SKKU: Sungkyunkwan University)
+ -1 AuthorsSu Jeong Song6
Estimated H-index: 6
(SKKU: Sungkyunkwan University)
Branch retinal vein occlusion is the second most common cause of retinal vascular disease after diabetic retinopathy.1,2 Many patients with BRVO experience a decrease in visual acuity because of macular edema, retinal ischemia or hemorrhage.2 The Branch Retinal Vein Occlusion Study demonstrated that eyes treated with argon laser photocoagulation for macular edema gained a mean improvement of visual acuity of 1.3 lines whereas the control group gained 0.2 lines.2 Recently, improvement in macular edema and visual acuity after intravitreal triamcinolone injections on macular edema in BRVO have been reported.3 However, these therapeutic results were not satisfactory in many cases because recurrent or persistent macular edema is common even after laser photocoagulation or intravitreal triamcinolone injections.4 After the first report by Osterloh and Chales in 1988, several investigators reported significant improvement of macular edema and visual acuity after arteriovenous sheathotomy for decompression of macular edema in BRVO.5-9 This surgical approach is based on the fact that BRVO takes place at the site of arteriovenous crossing where the artery and the vein shared a common vascular adventitia. Although the exact mechanism responsible for the improvement of visual acuity after vitrectomy and arteriovenous sheathotomy is still not clear, Mason et al reported that surgery halved the visual angle in 75% of patients compared with 40% of the control group.10 Charbonnel et al also reported visual acuity improvement of two ETDRS lines or more in 69% of patients with a mean gain of 1.9 ETDRS lines.11 However, most of these results are in eyes with relatively short BRVO duration and excluded the eyes with recurrent or persistent macular edema in BRVO after laser or intravitreal triamcinolone injections. The purpose of this study is to investigate the anatomic and functional results after arteriovenous sheathotomy with ILM peeling for persistent or recurrent macular edema in BRVO.
📖 Papers frequently viewed together
35 Citations
69 Citations
#1Rohit R. Lakhanpal (SC: University of Southern California)H-Index: 22
#2Michael JavaheriH-Index: 10
Last. Mark S. HumayunH-Index: 85
view all 5 authors...
PURPOSE: To evaluate a new technique, 25-gauge transvitreal limited arteriovenous-crossing manipulation without vitrectomy (LAM), for the treatment of branch retinal vein occlusion (BRVO) complicated by macular hemorrhage and/or macular edema recalcitrant to grid laser photocoagulation. METHODS: Twelve eyes of 12 patients underwent LAM for BRVO performed by a single surgeon (M.S.H.) using the 25-gauge nitinol flexible-extendable blunt pick. The presence or absence of intraoperative reperfusion v...
21 CitationsSource
BACKGROUND AND OBJECTIVE: To determine the efficacy of intravitreal triamcinolone acetonide (IVTA) in the early treatment of severe cystoid macular edema (CME) related to acute branch retinal vein occlusion. PATIENTS AND METHODS: Retrospective, non-comparative case series. Twelve eyes with severe CME (foveal thickness > 450 microm) secondary to acute branch retinal vein occlusion received IVTA. RESULTS: Average follow-up was 15.3 months. Mean visual acuity was 0.88 LogMar units (20/160) initiall...
31 CitationsSource
#1Jb Jonas (Heidelberg University)H-Index: 27
#2Imren Akkoyun (Heidelberg University)H-Index: 12
Last. Robert F. Degenring (Heidelberg University)H-Index: 27
view all 5 authors...
To evaluate the effect of intravitreal triamcinolone acetonide on visual acuity in branch retinal vein occlusion. The prospective comparative nonrandomized clinical interventional study included 28 patients (28 eyes) with branch retinal vein occlusion. The study group consisting of 10 consecutive patients received an intravitreal injection of 20–25 mg of triamcinolone acetonide. The control group including 18 patients did not receive an intravitreal injection. The mean follow-up was 8.7±4.4 mont...
142 CitationsSource
#1Abdullah Özkiriş (Erciyes University)H-Index: 14
#2Cem Evereklioglu (Erciyes University)H-Index: 30
Last. Özgür İlhan (Erciyes University)H-Index: 8
view all 4 authors...
PURPOSE. To evaluate the effectiveness of intravitreal triamcinolone acetonide as primary treatment of macular edema in branch retinal vein occlusion. METHODS. Fifteen eyes of 15 patients with macular edema due to branch retinal vein occlusion (Group 1) who received 8 mg/0.2 ml of intravitreal triamcinolone injection as primary treatment were retrospectively evaluated. The control group (Group 2) consisted of 19 eyes of 19 patients who had received laser treatment for macular edema. The main out...
32 CitationsSource
#1Shuichi Yamamoto (Chiba University)H-Index: 28
#2Wataru Saito (Hokkaido University)H-Index: 22
Last. S. Mizunoya (Chiba University)H-Index: 10
view all 6 authors...
Purpose compare the results of vitrectomy with or without arteriovenous (AV) crossing sheathotomy for macular edema associated with branch retinal vein occlusion (BRVO). Design Interventional case series. Methods A retrospective study of 36 eyes with BRVO-associated macular edema. Twenty eyes underwent AV sheathotomy (AS group), and 16 eyes underwent posterior vitreous detachment (PVD group). Best-corrected visual acuity (BCVA), fluorescein angiography (FA), and optical coherence tomography to d...
65 CitationsSource
#1José García-Arumí (Autonomous University of Barcelona)H-Index: 38
Last. Borja CorcósteguiH-Index: 24
view all 5 authors...
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
43 CitationsSource
Background: Currently, there is no proven treatment for macular edema due to central retinal vein occlusion (CRVO). Moreover, not all cases with macular edema due to branch retinal vein occlusion (BRVO) respond to laser photocoagulation. We postulated that internal limiting membrane (ILM) peeling for decompression of macular edema in cases of retinal vein occlusion would facilitate egress of blood and extracellular fluid out of the inner retinal layers, leading to reduction of macular edema and ...
113 CitationsSource
#1John O. MasonH-Index: 24
#2Richard M. FeistH-Index: 20
Last. Tracy L. EmondH-Index: 9
view all 6 authors...
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 sur...
68 CitationsSource
#1Jérôme Charbonnel (University of Paris)H-Index: 1
#2Agnès Glacet-Bernard (University of Paris)
Last. Gisèle Soubrane (University of Paris)H-Index: 53
view all 8 authors...
Background To analyze the results of vitrectomy and adventitial sheathotomy in the management of branch retinal vein occlusion (BRVO). This is a nonrandomized interventional case series.
69 CitationsSource
#1Dennis P. Han (MCW: Medical College of Wisconsin)H-Index: 52
#2Steven R. BennettH-Index: 18
Last. Sundeep DevH-Index: 20
view all 4 authors...
Purpose To evaluate visual outcome after arteriovenous (AV) crossing dissection for the treatment of branch retinal vein occlusion (BRVO) and secondary macular dysfunction in which difficulty separating the retinal vessels was experienced. Methods A pars plana vitrectomy and dissection of the involved AV crossing site were performed consecutively in 20 eyes of 20 patients with BRVO and vision loss. The overlying retinal artery was dissected free from the retinal surface, and separation of the ar...
27 CitationsSource
Cited By11
#1Gwang Myeong Noh (Kosin University)H-Index: 2
#2Chang Zoo Kim (Kosin University)H-Index: 1
Last. Sang Joon Lee (Kosin University)H-Index: 11
view all 4 authors...
#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...
27 CitationsSource
#1Gwang Myung Noh (Kosin University)H-Index: 1
#2Ji Eun Lee (Kosin University)H-Index: 3
Last. Sang Joon Lee (Kosin University)H-Index: 11
view all 5 authors...
Purpose: To identify the correlation between final visual outcome after at least 6 months of follow-up and the extent of macular ischemia on the first visit. Methods: We performed a retrospective clinical analysis of macular ischemia using clinical records, fundus examinations, and fluorescein angiographies in 83 patients (86 eyes) diagnosed with retinal vein occlusion from January 1998 to July 2012 and followed up for over 6 months. We evaluated the extent and the location of macular ischemia, ...
4 CitationsSource
#1Irini P. Chatziralli (QMUL: Queen Mary University of London)H-Index: 1
#1Irini Chatziralli (QMUL: Queen Mary University of London)H-Index: 21
Last. Marilita M Moschos (UoA: National and Kapodistrian University of Athens)H-Index: 26
view all 5 authors...
AbstractBackground: Retinal vein occlusion is the second most common retinal vascular disorder after diabetic retinopathy and is considered to be an important cause of visual loss. In this review, our purpose is to update the literature about the treatment alternatives for branch retinal vein occlusion. Methods: Eligible papers were identified by a comprehensive literature search of PubMed, using the terms “branch retinal vein occlusion,” “therapy,” “intervention,” “treatment,” “vitrectomy,” “sh...
14 CitationsSource
#1Einar Stefánsson (University of Iceland)H-Index: 69
ell into the twentieth century, most ophthalmologists considered the vitreous humor to be sacred and that any interference with the vitreous humor would have serious consequences for the eye. The vitreous was untouchable. Pioneering researchers changed this axiom, and towards the end of the century, vitreoretinal surgeons came to think of the vitreous gel almost as an inert substance, which could be freely operated, removed, and replaced for optical and structural reasons, with no consideration ...
1 CitationsSource
#1Arghavan Almony (MU: University of Missouri)H-Index: 13
#2Eric Nudleman (WashU: Washington University in St. Louis)H-Index: 14
Last. Asheesh TewariH-Index: 7
view all 7 authors...
Background:The internal limiting membrane represents the structural interface between the retina and the vitreous and has been postulated to serve several essential functions. Recently, internal limiting membrane peeling has been used in the treatment of a variety of retinal disorders. We review the
87 CitationsSource
#1David J. BrowningH-Index: 42
This chapter covers treatments in current use for retinal vein occlusion (RVO). Over time, many proposed treatments (e.g., radial optic neurotomy for central retinal vein occlusion (CRVO)) have been tried and discarded as evidence accumulates of inefficacy or too many adverse events. These treatments are covered, mainly for historical purposes, in Chap. 15. On the other hand, some treatments are not adopted because of impracticality or cost-benefit considerations, rather than because of ineffica...
1 CitationsSource
#1Angel Salinas-Alamán (University of Navarra)H-Index: 13
#2Javier Zarranz-Ventura (University of Navarra)H-Index: 18
Last. Alfredo García-Layana (University of Navarra)H-Index: 25
view all 6 authors...
PurposeTO evaluate intravitreal bevacizumab (IVB) combined with grid laser photocoagulation in macular edema (ME) secondary to branch retinal vein occlusion (BRVO).MethodsEight eyes (8 patients) with ME associated with BRVO with at least 3 months of evolution since symptom onset were included. All subjects underwent measurement of best-corrected visual acuity (BCVA) and imaging with spectral domain optical coherence tomography (SD-OCT) at baseline and 1, 3, 6, and 12 months. Intravitreal bevaciz...
18 CitationsSource
Vitreous surgery has various physiological and clinical consequences, both beneficial and harmful. Vitrectomy reduces the risk of retinal neovascularization, while increasing the risk of iris neovascularization, reduces macular edema and stimulates cataract formation. These clinical consequences may be understood with the help of classical laws of physics and physiology. The laws of Fick, Stokes-Einstein and Hagen-Poiseuille state that molecular transport by diffusion or convection is inversely ...
202 CitationsSource
#1Rehák J (Palacký University, Olomouc)H-Index: 6
#2Matus Rehak (Leipzig University)H-Index: 18
In branch retinal vein occlusion (BRVO), abnormal arteriovenous crossing with vein compression, degenerative changes of the vessel wall and abnormal hematological factors constitute the primary mechanism of vessel occlusion. In general, BRVO has a good prognosis: 50–60% of eyes are reported to have a final visual acuity (VA) of 20/40 or better even without treatment. One important prognostic factor for final VA appears to be the initial VA. Grid laser photocoagulation is an established treatment...
293 CitationsSource