Abstract
Background
Central retinal vein occlusion (CRVO) is a common retinal vascular disorder and a leading cause of visual loss. It is thought to arise from vascular obstruction at the level of the lamina cribrosa. The purpose of the study reported here was to evaluate the potential benefit of radial optic neurotomy (RON) and determine its effect on foveal thickness and macular volume in patients with CRVO.
Methods
We conducted a prospective pilot study of ten patients with CRVO. Visual acuity (VA) score measured with the Early Treatment Diabetic Retinopathy Study chart and the corresponding Snellen equivalent were assessed before and 6 months after surgery. Colour fundus photography, fluorescein angiography (FA) and optical coherence tomography (OCT) were carried out before and at 2, 6, 12 and 24 weeks after surgery. Foveal thickness and macular volumes were assessed using OCT.
Results
Visible reperfusion was observed in four of the ten patients at the time of surgery. VA score improved in eight of the ten patients from a median score of 11.50 (range 0–68) to a median score of 35.00 (range 3–79). Macular volumes decreased in six of seven patients from a median of 4.99 mm3 (range 2.68–6.77) to a median of 3.11 mm3 (range 1.11–5.02). Foveal thickness decreased in six of seven patients from a median of 596.50 μm (range 338.50–745.50) to a median of 330.50 μm (range 118–634.50). Six of ten patients developed a chorioretinal venous anastomosis. Macular oedema on OCT persisted in six of ten patients.
Conclusions
We observed an improvement in VA score and a corresponding reduction in foveal thickness and macular volume following RON, but macular oedema persisted in 60% of patients. Whilst optimisation of patient selection criteria remains a challenge, this pilot study suggests that RON has a beneficial effect on VA in patients presenting with CRVO.
Similar content being viewed by others
References
ETDRS report number 7 (1991) Early treatment diabetic retinopathy study design and baseline patient characteristics. Ophthalmology 98:741–756
Garcia-Arumi J, Boixadera A, Martinez-Castillo V, Castillo R, Dou A, Corcostegui B (2003) Chorioretinal anastomosis after radial optic neurotomy for central retinal vein occlusion. Arch Ophthalmol 121:1385–1391
Green WR, Chan CC, Hutchins GM, Terry JM (1981) Central retinal vein occlusion: a prospective histopathologic study of 29 eyes in 28 cases. Trans Am Ophthalmol Soc 79:371–422
Greenberg PB, Martidis A, Rogers AH, Duker JS, Reichel E (2002) Intravitreal triamcinolone acetonide for macular oedema due to central retinal vein occlusion. Br J Ophthalmol 86:247–248
Hansen LL, Wiek J, Wiederholt M (1989) A randomised prospective study of treatment of non-ischaemic central retinal vein occlusion by isovolaemic haemodilution. Br J Ophthalmol 73:895–899
Hayreh SS, Klugman MR, Beri M, Kimura AE, Podhajsky P (1990) Differentiation of ischemic from non-ischemic central retinal vein occlusion during the early acute phase. Graefes Arch Clin Exp Ophthalmol 228:201–217
Kohner EM, Pettit JE, Hamilton AM, Bulpitt CJ, Dollery CT (1976) Streptokinase in central retinal vein occlusion: a controlled clinical trial. Br Med J 1:550–553
Lahey JM, Fong DS, Kearney J (1999) Intravitreal tissue plasminogen activator for acute central retinal vein occlusion. Ophthalmic Surg Lasers 30:427–434
Lit ES, Tsilimbaris M, Gotzaridis E, D’Amico DJ (2002) Lamina puncture: pars plana optic disc surgery for central retinal vein occlusion. Arch Ophthalmol 120:495–499
McAllister IL, Douglas JP, Constable IJ, Yu DY (1998) Laser-induced chorioretinal venous anastomosis for nonischemic central retinal vein occlusion: evaluation of the complications and their risk factors. Am J Ophthalmol 126:219–229
Opremcak EM, Bruce RA, Lomeo MD, Ridenour CD, Letson AD, Rehmar AJ (2001) Radial optic neurotomy for central retinal vein occlusion: a retrospective pilot study of 11 consecutive cases. Retina 21:408–415
Samuel MA, Desai UR, Gandolfo CB (2003) Peripapillary retinal detachment after radial optic neurotomy for central retinal vein occlusion. Retina 23:580–583
The Central Vein Occlusion Study (1993) Baseline and early natural history report. Arch Ophthalmol 111:1087–1095
The Central Vein Occlusion Study Group (1997) Natural history and clinical management of central retinal vein occlusion. Arch Ophthalmol 115:486–491
The Eye Disease Case-Control Study Group (1996) Risk factors for central retinal vein occlusion. Arch Ophthalmol 114:545–554
Weiss JN, Bynoe LA (2001) Injection of tissue plasminogen activator into a branch retinal vein in eyes with central retinal vein occlusion. Ophthalmology 108:2249–2257
Weizer JS, Stinnett SS, Fekrat S (2003) Radial optic neurotomy as treatment for central retinal vein occlusion. Am J Ophthalmol 136:814–819
Williamson TH, Poon W, Whitefield L, Strothidis N, Jaycock P, Strothoudis N (2003) A pilot study of pars plana vitrectomy, intraocular gas, and radial neurotomy in ischaemic central retinal vein occlusion. Br J Ophthalmol 87:1126–1129
Author information
Authors and Affiliations
Corresponding author
Additional information
The authors have no proprietary or financial interests in the work presented
Rights and permissions
About this article
Cite this article
Zambarakji, H.J., Ghazi-Nouri, S., Schadt, M. et al. Vitrectomy and radial optic neurotomy for central retinal vein occlusion: effects on visual acuity and macular anatomy. Graefe's Arch Clin Exp Ophthalmol 243, 397–405 (2005). https://doi.org/10.1007/s00417-004-1046-0
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00417-004-1046-0