Vitrectomy with Neurotomy of the Optic Nerve for the Treatment of Central Retinal Vein Occlusion (CRVO) - a Pilot Study
Schmidt J. C., Meyer C. H., Hörle S.
Dept. of Ophthalmology, Philipps University, Marburg
Purpose: The proposed location of central retina vein occlusions (CRVO) is the at the lamina crbrosa. Current treatment modalities with rheologic treatments and laser photocoagulation frequently achieve poor funktional results.
Method: Seven Patienten aged 63-86 with a visual acuity < 0,3 due to a hämorrhagic CRVO were treated by pars plana vitrectomy (PPV) with remonal of the Membrana limitans interna as well as a separation of the der scleral sheeth at the nasal rim of the optic nerve. mPre- and postoperativly we evaluated Snellen visual acuity, fluorescein angiography and optical coherence tomography (OCT).
Results: The scleral sheath was cut by a lancet without severe bleedings in all patients. During the follow-up periode of 3 - 6 months a significant decrease of the intraretinal bleedings and reduction of the macular edema on OCT was determined in all patients. Vision improved to 20/200 - 20/400 in all Patients. No patient developed rubeosis requiring panretinal photocoagulation.
Conclusions: PPV with consecutive neurotomy seems to improve the retinal haemodynamic in eyes with CRVO. Although most intraretinal hemorrhages reabsorbe, macular edema persists, limiting the postoperative visual improvement to 0,2. During the follow-up period no iris proliferation occurred requiring panretinal photocoagulation. Further studies a
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