Vitrectomy with or without arteriovenous adventitial sheathotomy for macular edema associated with branch retinal vein occlusion - 25/08/11

Doi : 10.1016/j.ajo.2004.06.061

Shuichi Yamamoto, MD, PhD ^a,⁎ , Wataru Saito, MD, PhD ^b, Fumihiko Yagi, MD ^c, Shinobu Takeuchi, MD, PhD ^d, Eiju Sato, MD, PhD ^a, Satoshi Mizunoya, MD, PhD ^a
^a Department of Ophthalmology and Visual Science, Chiba University Graduate School of Medicine, Chiba
^b Department of Ophthalmology, Hokkaido University School of Medicine, Sapporo
^c Department of Ophthalmology, Toho University Sakura Hospital, Sakura
^d 2nd Department of Ophthalmology, Toho University School of Medicine, Tokyo, Japan.

^*Inquiries to Shuichi Yamamoto, MD, PhD, Department of Ophthalmology and Visual Science, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba 260-8670, Japan; fax: (+81) 43-227-1810;

Résumé

Purpose

compare the results of vitrectomy with or without arteriovenous (AV) crossing sheathotomy for macular edema associated with branch retinal vein occlusion (BRVO).

Design

Interventional case series.

Methods

A retrospective study of 36 eyes with BRVO-associated macular edema. Twenty eyes underwent AV sheathotomy (AS group), and 16 eyes underwent posterior vitreous detachment (PVD group). Best-corrected visual acuity (BCVA), fluorescein angiography (FA), and optical coherence tomography to determine foveal thickness were conducted preoperatively and at 12 months postoperatively.

Results

The mean postoperative BCVAs were significantly better in both the AS and the PVD group (P = .008 and P = .001, respectively). Foveal thickness decreased 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 improvement of BCVA and foveal thickness were not significantly different for the two groups at any postoperative period. Postoperative FA showed reperfusion of the occluded 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.

Conclusions

Both AV sheathotomy and simple PVD significantly reduced macular edema associated with BRVO. However, there was no significant difference in the improvement of macular function following either procedure. Postoperative improvement of retinal circulation by either reperfusion of the occluded vein or collateral vessel formation was found. This accounted for functional and morphologic improvements.

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