Laser treatment and the mechanism of edema reduction in branch retinal vein occlusion.
OBJECTIVE
To test a hypothesis on the physiological mechanism of the disappearance of macular edema after laser treatment. The hypothesis is based on the effect grid laser treatment has on retinal oxygenation and hemodynamics. It predicts that laser-induced reduction of macular edema is associated with shortening and narrowing of retinal vessels in patients with branch retinal vein occlusion (BRVO).


METHODS
The study included 12 subjects, treated with argon laser photocoagulation for BRVO and macular edema. Fundus photographs taken at the time of diagnosis and again after laser treatment, were digitized, and diameter and segment length of retinal vessels was measured using NIH-Image program.


RESULTS
Macular edema disappeared or was dramatically reduced in all cases after laser treatment. The diameter of occluded venules constricted to 0.81+/-0.02 (mean +/- SD, P = 0.019) of the prelaser diameter and adjacent arterioles constricted to 0.78+/-0.01 (P = 0.008). The laser treatment also led to shortening of the affected vessels. The final segment length of the occluded venules was 0.95+/-0.17 (P = 0.005) of the length before treatment. The corresponding value for the adjacent arterioles is 0.95+/-0.14 (P = 0.008). Control arterioles and venules in the same fundus did not change in either length or width.


CONCLUSIONS
These results do not reject the authors' hypothesis that the disappearance of macular edema in BRVO can be explained by the effect the laser photocoagulation has on retinal oxygenation. Increased oxygenation causes vessel constriction and shortening and lower intravascular pressure, which reduces edema formation according to Starling's law.
Arnarsson
A
A
Department of Ophthalmology, University of Iceland, Reykjavik.
Stefánsson
E
E
D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005654:Fundus Oculi; D006801:Humans; D017075:Laser Coagulation; D008269:Macular Edema / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010100:Oxygen / Q000378:metabolism; D012161:Retinal Artery / Q000378:metabolism / Q000503:physiopathology; D012169:Retinal Vein / Q000378:metabolism / Q000503:physiopathology*; D012170:Retinal Vein Occlusion / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D014792:Visual Acuity
D010100:Oxygen