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DOI: 10.1055/s-0028-1109257
© Georg Thieme Verlag KG Stuttgart · New York
Arteriovenöse Dissektion (AVD) bei retinalen Venolenastverschlüssen
Arteriovenous Crossing Sheathotomy in Branch Retinal Vein OcclusionPublication History
Eingegangen: 1.9.2008
Angenommen: 12.11.2008
Publication Date:
21 April 2009 (online)

Zusammenfassung
Hintergrund: Untersuchung der arteriovenösen Dissektion (AVD) bei retinalen Venolenastthrombosen mit langer Nachbeobachtung und systematischer Überprüfung des Gesichtsfeldes. Patienten und Methode: In einer klinischen Interventionsstudie wurden konsekutiv 36 Augen mit retinalen Venolenastthrombosen (22 × klinische Ischämie, 14 × persistierendes Makulaödem) nach 3 Monaten erfolgloser isovolämischer Hämodilution anschließend durch Vitrektomie mit AVD und Peeling der Membrana limitans interna behandelt. Ergebnisse: Alle Augen zeigten nach 3 Monaten eine deutliche Rückbildung des Makulaödems. Im Kontrollintervall (Median 26,4 Monate) wurde eine Visusbesserung in 24 / 36 Augen und Visusstabilisierung in 8 / 36 Augen festgestellt. An Komplikationen beobachteten wir subretinale Blutungen an der Dissektionsstelle (5), Glaskörperblutungen (12) und periphere Netzhautforamina (2). Die Goldmann-Perimetrie zeigte in 3 / 36 Augen mit relativ papillennahen AVDs parazentrale absolute Skotome, die mit der Dissektionstelle korrelierten. In 16 / 22 Augen mit ischämischen Verschlüssen war die Gesichtsfeldaußengrenze im betroffenen Quadranten eingeengt. Schlussfolgerung: Die Behandlungsergebnisse retinaler Venolenastthrombosen durch Vitrektomie mit Entfernung der Membrana limitans interna und AV-Dissektion sind ermutigend, weil trotz vorheriger erfolgloser Hämodilution noch in 67 % der Augen ein Sehschärfenanstieg erreicht wurde. Parazentrale Gesichtsfeldausfälle scheinen besonders bei papillennaher Dissektion möglich.
Abstract
Background: The aim of this study is to report on arteriovenous sheathotomy in branch retinal vein occlusion (BRVO) with a long-term follow-up and examine the visual field effects of this surgical approach. Patients and Methods: In a clinical trial 36 eyes with branch retinal vein occlusion (22 eyes with ischaemia, 14 eyes with chronic macular oedema) underwent surgical decompression accompanied by peeling of the membrana limitans interna after prior isovolemic haemodilution for 3 months had been unsuccessfull. Results: All eyes showed a significant reduction of macular oedema 3 months after surgery. During follow-up (median: 26.4 months) visual acuity increased in 24 / 36 eyes and was stabilised in 8 / 36 eyes. We observed haemorrhages at the dissection site (5 × ), vitreous haemorrhages (12 × ) and retinal holes at the vitreous base (2 × ). Goldmann perimetry revealed paracentral scotomas in 3 eyes, which had been treated by arteriovenous dissection relatively close to the optic disc. In 16 / 22 eyes with ischaemic thromboses the visual field was narrowed in the affected quadrant. Conclusions: The results of arteriovenous sheathotomy in BRVO are encouraging because we observed increase of visual acuity in 67 % of the eyes in spite of an unsuccessful haemodilution during 3 months before. However, whether its benefits outweigh potential surgical complications as visual field defects remains to be determined.
Schlüsselwörter
AV-Dissektion - Sheathotomie - Venolenastverschlüsse - Netzhaut - Gesichtsfeld
Key words
arteriovenous dissection - sheathotomy - branch retinal vein occlusion - retina - visual field
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PD Dr. med. Bernhard Stoffelns
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