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Treatment of retinal artery occlusion using transluminal Nd:YAG laser: a systematic review and meta-analysis

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Abstract

Aims

To review clinical experience, efficacy, and safety of transluminal Nd:YAG laser embolectomy/embolysis (TYE) for retinal artery occlusion. Methods: Electronic databases were searched for all published clinical studies and case-reports reporting on TYE in central (CRAO) or branch (BRAO) retinal artery occlusion. Individual patient data was evaluated in a weighted pooled analysis.

Results

Sixty-one cases were reported, 47 with BRAO and 14 with CRAO. Visual acuity (VA) at onset averaged 20/252 (1.1 LogMAR) and improved following the procedure to 20/47 (0.37 LogMAR) at first follow-up (avg. 6 days, P < 0.001) and to 20/30 (0.18 LogMAR) at last reported follow-up (avg. 1.1 years, P = 0.02). Patients with worse VA (<20/200) improved further (12 vs. three lines, P < 0.001). VA was not improved when using higher pulse energies (≥ 2.4 mJ) which were associated with more vitrectomies. In a weighted analysis vitreous/sub-retinal hemorrhage was estimated to occur in 54% of cases and required vitrectomy in 18% of cases.

Conclusions

TYE was followed by significant visual improvement in the vast majority of cases, including CRAO, and was frequently associated with vitreous hemorrhage. Patients with poor visual acuity appear to benefit further and higher pulse energies may be detrimental. Lack of randomization and intrinsic biases prevent any definite conclusions regarding the benefits and further research is warranted.

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Author information

Author notes

  1. Vitaly Man and Idan Hecht contributed equally to this work.

Authors and Affiliations

  1. Department of Ophthalmology, Soroka University Medical Center, Beer Sheva, Israel

    Vitaly Man & Idan Hecht

  2. Ben-Gurion University, Beer-Sheva, Israel

    Vitaly Man

  3. Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel

    Idan Hecht, Mohamad Midlij, Zvia Burgansky-Eliash & Asaf Achiron

  4. Department of Statistics and Operation Research, Tel-Aviv University, Tel Aviv, Israel

    Michal Talitman

  5. The Hebrew University of Jerusalem, Jerusalem, Israel

    Assaf Hilely

  6. Department of Ophthalmology, Kaplan Medical Center, Rehovot, Israel

    Assaf Hilely

  7. Department of Ophthalmology, Edith Wolfson Medical Center, Holon, Israel

    Mohamad Midlij, Zvia Burgansky-Eliash & Asaf Achiron

Authors
  1. Vitaly Man
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Correspondence to Idan Hecht.

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Funding

This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

Conflict of interest

All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.

Ethical approval

All procedures performed in studies involving humanparticipants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study formal consent is not required.

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Supplemental Figure 1

Flow Diagram of the Inclusion Process (DOCX 30 kb)

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Man, V., Hecht, I., Talitman, M. et al. Treatment of retinal artery occlusion using transluminal Nd:YAG laser: a systematic review and meta-analysis. Graefes Arch Clin Exp Ophthalmol 255, 1869–1877 (2017). https://doi.org/10.1007/s00417-017-3777-8

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  • DOI: https://doi.org/10.1007/s00417-017-3777-8

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