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Venous retinal flow reperfusion mechanisms following radial optic neurotomy with adjunctive intraocular triamcinolone in central retinal vein occlusion.

Fortunato P, Pollazzi L, Baroni M, Evangelisti A, La Torre A - Graefes Arch. Clin. Exp. Ophthalmol. (2009)

Bottom Line: No complications were noted in any of the patients.Surgical decompression promoted mechanical reperfusion of the occluded vessel in 10/13 (77%) cases.In 6/13 patients (46%) reperfusion occurred within 2 weeks of surgery, and in 4/13 patients (31%) collateral vessels formed within 4 months.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgical Oto-Neuro-Ophthalmology Sciences, University of Florence, Viale Morgagni, 85-50134 Florence, Italy. pinfor@tin.it

ABSTRACT

Background: To evaluate retinal reperfusion, anastomosis, and compensation following radial optic neurotomy for ischemic nonperfused central retinal vein occlusion.

Methods: Prospective, non-comparative, interventional case series of 13 patients with ischemic, nonperfused central retinal vein occlusion who underwent decompression surgery with a radial optic neurotomy and adjunctive intraocular triamcinolone. Patients were followed for 1 year after surgery, and were analyzed in the preoperative and postoperative stages determining: visual acuity by ETDRS chart (LogMar) and retinal thickness with optical coherence tomography. Fluorescein angiography was performed at regular intervals to evaluate the capillary perfusion grade. Intraocular pressure was measured and fundus was examined.

Results: Visual acuity and retinal thickness improved in 10/13 (77%) patients after surgery at 1-year follow-up. Adequate retinal reperfusion was achieved in ten of the 13 eyes. Acute reperfusion occurred in six eyes within 2 weeks of surgery and a shunt vessel at the optic disk developed in four eyes within 4 months. In the remaining three eyes, retinal reperfusion was not observed by fluorescein angiography. No complications were noted in any of the patients.

Conclusion: Surgical decompression promoted mechanical reperfusion of the occluded vessel in 10/13 (77%) cases. In 6/13 patients (46%) reperfusion occurred within 2 weeks of surgery, and in 4/13 patients (31%) collateral vessels formed within 4 months.

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Scatter plot of the pre- and post-operative values of Snellen Visual Acuity (the regression line showed is for illustrative purpose only)
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Fig4: Scatter plot of the pre- and post-operative values of Snellen Visual Acuity (the regression line showed is for illustrative purpose only)

Mentions: In the first place, visual acuity values showed a significant difference after surgery (p < 0.05) (Fig. 4). It is important to stress that not one of the 13 patients experienced a worsening in VA, not even those patients (3/13, 23%) where retinal reperfusion after RON was not achieved. Best-corrected visual acuity, with an average gain of five Snellen lines, was observed in 4/13 (31%) patients, where an anastomosis appeared at the RON incision site. The remaining 6/13 (46%) patients gained at least two Snellen lines.Fig. 4


Venous retinal flow reperfusion mechanisms following radial optic neurotomy with adjunctive intraocular triamcinolone in central retinal vein occlusion.

Fortunato P, Pollazzi L, Baroni M, Evangelisti A, La Torre A - Graefes Arch. Clin. Exp. Ophthalmol. (2009)

Scatter plot of the pre- and post-operative values of Snellen Visual Acuity (the regression line showed is for illustrative purpose only)
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2801847&req=5

Fig4: Scatter plot of the pre- and post-operative values of Snellen Visual Acuity (the regression line showed is for illustrative purpose only)
Mentions: In the first place, visual acuity values showed a significant difference after surgery (p < 0.05) (Fig. 4). It is important to stress that not one of the 13 patients experienced a worsening in VA, not even those patients (3/13, 23%) where retinal reperfusion after RON was not achieved. Best-corrected visual acuity, with an average gain of five Snellen lines, was observed in 4/13 (31%) patients, where an anastomosis appeared at the RON incision site. The remaining 6/13 (46%) patients gained at least two Snellen lines.Fig. 4

Bottom Line: No complications were noted in any of the patients.Surgical decompression promoted mechanical reperfusion of the occluded vessel in 10/13 (77%) cases.In 6/13 patients (46%) reperfusion occurred within 2 weeks of surgery, and in 4/13 patients (31%) collateral vessels formed within 4 months.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgical Oto-Neuro-Ophthalmology Sciences, University of Florence, Viale Morgagni, 85-50134 Florence, Italy. pinfor@tin.it

ABSTRACT

Background: To evaluate retinal reperfusion, anastomosis, and compensation following radial optic neurotomy for ischemic nonperfused central retinal vein occlusion.

Methods: Prospective, non-comparative, interventional case series of 13 patients with ischemic, nonperfused central retinal vein occlusion who underwent decompression surgery with a radial optic neurotomy and adjunctive intraocular triamcinolone. Patients were followed for 1 year after surgery, and were analyzed in the preoperative and postoperative stages determining: visual acuity by ETDRS chart (LogMar) and retinal thickness with optical coherence tomography. Fluorescein angiography was performed at regular intervals to evaluate the capillary perfusion grade. Intraocular pressure was measured and fundus was examined.

Results: Visual acuity and retinal thickness improved in 10/13 (77%) patients after surgery at 1-year follow-up. Adequate retinal reperfusion was achieved in ten of the 13 eyes. Acute reperfusion occurred in six eyes within 2 weeks of surgery and a shunt vessel at the optic disk developed in four eyes within 4 months. In the remaining three eyes, retinal reperfusion was not observed by fluorescein angiography. No complications were noted in any of the patients.

Conclusion: Surgical decompression promoted mechanical reperfusion of the occluded vessel in 10/13 (77%) cases. In 6/13 patients (46%) reperfusion occurred within 2 weeks of surgery, and in 4/13 patients (31%) collateral vessels formed within 4 months.

Show MeSH
Related in: MedlinePlus