compare the results of vitrectomy with or without arteriovenous (AV) crossing sheathotomy for macular edema associated with branch retinal vein occlusion (BRV O). Interventional case series. A retrospective study of 3...compare the results of vitrectomy with or without arteriovenous (AV) crossing sheathotomy for macular edema associated with branch retinal vein occlusion (BRV O). Interventional case series. A retrospective study of 36 eyes with BRVO-asso ciated macular edema. Twenty eyes underwent AV sheathotomy (AS group), and 16 ey es underwent posterior vitreous detachment (PVD group). Best-corrected visual a cuity (BCVA), fluorescein angiography (FA), and optical coherence tomography to determine foveal thickness were conducted preoperatively and at 12 months postop eratively. The mean postoperative BCVAs were significantly better in both the AS and the PVD group (P =. 008 and P=. 001, respectively). Foveal thickness decrea sed significantly 1 month after surgery in both groups (P=. 002 and P=. 007) and continued to decrease up to 12 months. The postoperative mean BCVA and improvem ent of BCVA and foveal thickness were not significantly different for the two gr oups at any postoperative period. Postoperative FA showed reperfusion of the occ luded vein in 10 eyes in the AS group and 2 eyes in the PVD group, and formation of shunt vessels at the AV crossing site or around the macular region in all of the other eyes of both groups. Both AV sheathotomy and simple PVD significantly reduced macular edema associated with BRVO. However, there was no significant d ifference in the improvement of macular function following either procedure. Pos toperative improvement of retinal circulation by either reperfusion of the occlu ded vein or collateral vessel formation was found. This accounted for functional and morphologic improvements.展开更多
Background: Arteriovenous dissection (sheathotomy) is a new therapeutic option in patients with branch retinal vein occlusion (BRVO) and macular involvement. We present an angiographic follow-up of 22 patients who und...Background: Arteriovenous dissection (sheathotomy) is a new therapeutic option in patients with branch retinal vein occlusion (BRVO) and macular involvement. We present an angiographic follow-up of 22 patients who underwent arteriovenous dissection (AVD). Methods: Twenty-two patients (15 women; mean age 68.7±8.0 y ears) were examined preoperatively and 6 weeks, 3 months, 6 months, and 1 year a fter AVD. For assessment of retinal hemodynamics, arteriovenous passage time (AV P) of the affected and unaffected branches at first (AVPe) and at maximal (AVPma x) venous filling were measured. Changes in the foveal avascular zone (FAZ)were calculated to determine foveal structural changes. Visual acuity was assessed as functional parameter. Results: The early AVP (AVPe) of the affected branch incr eased from 4.4±0.8 s preoperatively to 4.9±0.6 s 6 weeks after surgery and dec reased to 2.7±0.4 s 1 year after surgery (p=0.05). When compared to the unaffec ted control branch, AVPe was significantly increased in the affected branch preo peratively (4.5±0.8 s versus 1.5±0.2 s, p< 0.01), 6 weeks (4.9±0.6 s versus 2 .1±0.3 s, p< 0.01), 3 months (2.7±0.4 s versus 1.5±0.2 s, p < 0.01), and 6 mo nths (3.1±0.4 s versus 2.2±0.3 s, p=0.02) after AVD. After 1 year, AVPe no lon ger differed between the affected and the control branch (2.7±0.4 s versus 2.6 ±0.3 s). AVPmax was significantly increased in the affected branch preoperative ly (11.8±0.8 s versus 7.7±1.0 s, p < 0.05). The AVPmax in the affected branch with the exception of 3 months after surgery (10.2±1.1 s, p < 0.01) was no long er elevated when compared to preoperative values. The area of the FAZ did not ch ange significantly but showed a trend for enlargement. Conclusion: AVD for decom pression of BRVO leads to a significant decrease of AVP and may ameliorate retin al perfusion in the affected branch.展开更多
To describe a patient with a central retinal vein occlusion (CRVO) who developed central retinal artery occlusion after radial optic neurotomy. Interventional case report. A 70- year old woman with CRVO underwent a ra...To describe a patient with a central retinal vein occlusion (CRVO) who developed central retinal artery occlusion after radial optic neurotomy. Interventional case report. A 70- year old woman with CRVO underwent a radial optic neurotomy on her right eye. Her preoperative visual acuity in the affected eye was 20/400. Radial optic neurotomy was performed after phacoemulsification and aspiration for a cataract with intraocular lens implantation. At the insertion of a CRVO knife, pulsating bleeding occurred from the cup of the optic disk; the bleeding was stopped within 2 minutes by elevating the intraocular pressure to 80 mm Hg. On the following day, the patient noticed that she had lost light perception. Fluorescein angiography showed a marked delay of arterial filling, indicating a central retinal artery occlusion. Retinal circulation returned to normal 2 months later; however, her vision was still no light perception. Ophthalmologists should be aware that severe complications such as central retinal artery occlusion can be associated with radial optic neurotomy,which is an unproven surgical procedure with a questionable pathophysiologic mechanism.展开更多
文摘compare the results of vitrectomy with or without arteriovenous (AV) crossing sheathotomy for macular edema associated with branch retinal vein occlusion (BRV O). Interventional case series. A retrospective study of 36 eyes with BRVO-asso ciated macular edema. Twenty eyes underwent AV sheathotomy (AS group), and 16 ey es underwent posterior vitreous detachment (PVD group). Best-corrected visual a cuity (BCVA), fluorescein angiography (FA), and optical coherence tomography to determine foveal thickness were conducted preoperatively and at 12 months postop eratively. The mean postoperative BCVAs were significantly better in both the AS and the PVD group (P =. 008 and P=. 001, respectively). Foveal thickness decrea sed significantly 1 month after surgery in both groups (P=. 002 and P=. 007) and continued to decrease up to 12 months. The postoperative mean BCVA and improvem ent of BCVA and foveal thickness were not significantly different for the two gr oups at any postoperative period. Postoperative FA showed reperfusion of the occ luded vein in 10 eyes in the AS group and 2 eyes in the PVD group, and formation of shunt vessels at the AV crossing site or around the macular region in all of the other eyes of both groups. Both AV sheathotomy and simple PVD significantly reduced macular edema associated with BRVO. However, there was no significant d ifference in the improvement of macular function following either procedure. Pos toperative improvement of retinal circulation by either reperfusion of the occlu ded vein or collateral vessel formation was found. This accounted for functional and morphologic improvements.
文摘Background: Arteriovenous dissection (sheathotomy) is a new therapeutic option in patients with branch retinal vein occlusion (BRVO) and macular involvement. We present an angiographic follow-up of 22 patients who underwent arteriovenous dissection (AVD). Methods: Twenty-two patients (15 women; mean age 68.7±8.0 y ears) were examined preoperatively and 6 weeks, 3 months, 6 months, and 1 year a fter AVD. For assessment of retinal hemodynamics, arteriovenous passage time (AV P) of the affected and unaffected branches at first (AVPe) and at maximal (AVPma x) venous filling were measured. Changes in the foveal avascular zone (FAZ)were calculated to determine foveal structural changes. Visual acuity was assessed as functional parameter. Results: The early AVP (AVPe) of the affected branch incr eased from 4.4±0.8 s preoperatively to 4.9±0.6 s 6 weeks after surgery and dec reased to 2.7±0.4 s 1 year after surgery (p=0.05). When compared to the unaffec ted control branch, AVPe was significantly increased in the affected branch preo peratively (4.5±0.8 s versus 1.5±0.2 s, p< 0.01), 6 weeks (4.9±0.6 s versus 2 .1±0.3 s, p< 0.01), 3 months (2.7±0.4 s versus 1.5±0.2 s, p < 0.01), and 6 mo nths (3.1±0.4 s versus 2.2±0.3 s, p=0.02) after AVD. After 1 year, AVPe no lon ger differed between the affected and the control branch (2.7±0.4 s versus 2.6 ±0.3 s). AVPmax was significantly increased in the affected branch preoperative ly (11.8±0.8 s versus 7.7±1.0 s, p < 0.05). The AVPmax in the affected branch with the exception of 3 months after surgery (10.2±1.1 s, p < 0.01) was no long er elevated when compared to preoperative values. The area of the FAZ did not ch ange significantly but showed a trend for enlargement. Conclusion: AVD for decom pression of BRVO leads to a significant decrease of AVP and may ameliorate retin al perfusion in the affected branch.
文摘To describe a patient with a central retinal vein occlusion (CRVO) who developed central retinal artery occlusion after radial optic neurotomy. Interventional case report. A 70- year old woman with CRVO underwent a radial optic neurotomy on her right eye. Her preoperative visual acuity in the affected eye was 20/400. Radial optic neurotomy was performed after phacoemulsification and aspiration for a cataract with intraocular lens implantation. At the insertion of a CRVO knife, pulsating bleeding occurred from the cup of the optic disk; the bleeding was stopped within 2 minutes by elevating the intraocular pressure to 80 mm Hg. On the following day, the patient noticed that she had lost light perception. Fluorescein angiography showed a marked delay of arterial filling, indicating a central retinal artery occlusion. Retinal circulation returned to normal 2 months later; however, her vision was still no light perception. Ophthalmologists should be aware that severe complications such as central retinal artery occlusion can be associated with radial optic neurotomy,which is an unproven surgical procedure with a questionable pathophysiologic mechanism.
