Long-Term Functional and Anatomical Outcome of Radial Optic Neurotomy for Central Retinal Vein Occlusion

Abstract

Background: Without treatment, the natural history of central retinal vein occlusion (CRVO) can result in severe loss of vision. Material and Methods: This was a retrospective study of 10 eyes with CRVO treated with pars plana vitrectomy (PPV), combined with radial optic neurotomy. The patients completed a minimum of 5 years follow-up. Results: Median age at the time of surgery was 67 ± 14 years. Median follow-up was 79 ± 9 months. Ischaemic changes were present in 4 patients pre-operatively. Baseline median logMAR BCVA was 2.00 ± 0.76 and improved significantly to a median of 0.35 ± 0.54 (p < 0.0001, two tailed t test) at 5 years follow-up. The baseline median central macular thickness (CMT) was 645 ± 108 µm and improved significantly, to a median of 203 ± 72 µm (p < 0.0001, two tailed t test). One of the patients developed neovascular complications during the follow-up period. Conclusions: Our results compare very favorably with the natural history of CRVO. All patients demonstrated a trend to improved visual acuity, while only one of the patients developed neovascular complications. These results provide information on the potential long-term effect of PPV in patients with CRVO and may help to reassess the place of the surgical management of CRVO in patients who do not respond to medical treatment.

Zusammenfassung

Hintergrund: Die spontane Langzeitentwicklung des retinalen Zentralvenenverschlusses (CRVO) geht oft mit starkem Visusverlust einher. Patienten und Methoden: Retrospektive Untersuchung von 10 Augen mit CRVO, welche mittels Pars Plana Vitrektomie (PPV) kombiniert mit einer radialen Optikusneurotomie operiert wurden mit einer minimalen Nachkontrollzeit von 5 Jahren. Resultate: Das mittlere Alter war 67 ± 14 Jahre at the time of surgery. Die mittlere Nachkontrollzeit betrug 79 ± 9 Monate. Ischämische Veränderungen wurden präoperativ in 4 Patienten beobachtet. Der mittlere präoperative Visus betrug 2.00 ± 0.76 logMAR, welcher signifikant auf 0.35 ± 0.54 logMAR anstieg (p < 0.0001, two-tailed t-Test). Die mittlere präoperative Makuladicke betrug 645 ± 108 Mikrometer, welche signifikant auf 203 ± 72 Mikrometer anstieg (p < 0,0001, two-tailed t-Test). Ein Patient entwickelte neovaskuläre Komplikationen. Schlussfolgerungen: Diese Langzeit Ergebnisse zeigen einen Trend für eine verbesserte Visusentwicklung mit niedriger neovaskulären Komplikationsrate als nach Spontanentwicklung bei CRVO. Diese Ergebnisse können Anhaltspunkte zur Diskussion der Lanzeitwirkung einer PPV bei CRVO geben.

Key words

central retinal vein occlusion - pars plana vitrectomy - radial optic neurotomy

Schlüsselwörter

retinaler Zentralvenenverschluss - Pars Plana Vitrektomie - radiale Optikusneurotomie

• References

• 1 Natural history and clinical management of central retinal vein occlusion. The Central Vein Occlusion Study Group. Arch Ophthalmol 1997; 115: 486-491
• 2 Opremcak EM, Bruce RA, Lomeo MD et al. Radial optic neurotomy for central retinal vein occlusion: a retrospective pilot study of 11 consecutive cases. Retina 2001; 21: 408-415
• 3 Williamson TH, Grewal J, Gupta B et al. Measurement of PO2 during vitrectomy for central retinal vein occlusion, a pilot study. Graefes Arch Clin Exp Ophthalmol 2009; 247: 1019-1023
• 4 Noma H, Funatsu H, Mimura T et al. Visual acuity and foveal thickness after vitrectomy for macular edema. Ophthalmologica 2010; 224: 367-373
• 5 Opremcak EM, Rehmar AJ, Ridenour CD et al. Radial optic neurotomy for central retinal vein occlusion: 117 consecutive cases. Retina 2006; 26: 297-305
• 6 Binder S, Aggermann T, Brunner S. Long-term effects of radial optic neurotomy for central retinal vein occlusion consecutive interventional case series. Graefes Arch Clin Exp Ophthalmol 2007; 245: 1447-1452
• 7 Arevalo JF, Garcia RA, Wu L et al. Radial optic neurotomy for central retinal vein occlusion: results of the Pan-American Collaborative Retina Study Group (PACORES). Retina 2008; 28: 1044-1052
• 8 Holladay JT. Proper method for calculating average visual acuity. J Refract Surg 1997; 13: 388-391
• 9 Singh Hayreh S, Opremcak EM, Bruce RA et al. Radial optic neurotomy for central retinal vein obstruction. Retina 2002; 22: 374-377 author reply 377–379
• 10 Fortunato P, Pollazzi L, Baroni M et al. Venous retinal flow reperfusion mechanisms following radial optic neurotomy with adjunctive intraocular triamcinolone in central retinal vein occlusion. Graefes Arch Clin Exp Ophthalmol 2009; 248: 167-173
• 11 Hasselbach H, Thale A, Bunse A et al. Ultrastructural analysis of the lamina cribrosa after radial optic neurotomy. Ann Anat 2009; 191: 267-272