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, 20 (4), 210-4

Arteriovenous Sheathotomy for Persistent Macular Edema in Branch Retinal Vein Occlusion

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Arteriovenous Sheathotomy for Persistent Macular Edema in Branch Retinal Vein Occlusion

Joon Hong Sohn et al. Korean J Ophthalmol.

Abstract

Purpose: To evaluate the efficacy of arteriovenous (AV) sheathotomy with internal limiting membrane peeling for persistent or recurrent macular edema after intravitreal triamcinolone injection and/or laser photocoagulation in branch retinal vein occlusion.

Methods: Twenty-two eyes with branch retinal vein occlusion (BRVO) with recurrent macular edema underwent vitrectomy with AV sheathotomy and internal limiting membrane peeling. All eyes had previous intravitreal triamcinolone injection and/or laser photocoagulation for macular edema. The best corrected visual acuity (BCVA), fluorescein angiography and optical coherence tomography (OCT) before and after surgery were compared.

Results: The mean preoperative BCVA (log MAR) were 0.79 +/- 0.29 and postoperative BCVA (log MAR) at 3 months was 0.57 +/- 0.33. And improvement of visual acuity > or = 2 lines was observed in 10 eyes (45%). The mean preoperative fovea thickness measured by OCT was 595.22 +/- 76.83 microm (510-737 microm) and postoperative fovea thickness was 217.60 +/- 47.33 microm (164-285 microm).

Conclusions: Vitrectomy with AV sheathotomy can be one treatment option for the patients with recurrent macular edema in BRVO.

Figures

Fig. 1
Fig. 1
The relationship between the preoperative visual acuity and postoperative visual acuity. The improvement of visual acuity is statistically significant (p<0.01, Chi squared test). Preva: preoperative visual acuity (log MAR), Postva: postoperative visual acuity (log MAR)
Fig. 2
Fig. 2
Preoperative and postoperative fundus photography and OCT in a 64 year-old patient with BRVO. (visual acuity 0.1) (A) Widespread retina hemorrhage and exudation. (B) Preoperative fluorescein angiography of nonperfusion area after 3 months after laser and IVTA treatment. (C) Color fundus photography 1 year after surgery. (visual acuity 0.3). (D) Preoperative OCT showed cystoid macular edema with central foveal thickness 552 µm. E. Postoperative OCT with decreased macular edema with central foveal thickness 214 µm.
Fig. 3
Fig. 3
Preoperative and postoperative fundus photography and fluorescein angiography of a 67 year-old patient with inferotemporal BRVO (visual acuity 0.2). (A) Preoperative fluorescein angiography showing retina ischemia in inferotemporal area including macula 3 months after IVTA. (B) Postoperative fluorescein angiography at 1 year after surgery (visual acuity 0.4) with a lack of blocked fluorescence and minimal leakage. (C) Preoperative OCT with central fovea thickness 637 µm. (D) Postoperative OCT 15 months after surgery with fovea thickness 183 µm.

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