Vitrectomy with arteriovenous decompression and internal limiting membrane dissection in branch retinal vein occlusion.
OBJECTIVE
The therapeutic armamentarium for functional improvement after branch retinal vein occlusion (BRVO) is limited with uncertain efficacy. Some surgeons have proposed surgical decompression of the vein at the arteriovenous (AV) crossing.


METHODS
Forty-three patients with BRVO were treated in the authors' department from August 1999 to April 2001 with AV decompression. Twenty-five patients with comparable BRVO who refused this surgical intervention served as a control group. All 68 patients received an isovolemic hemodilution therapy for 10 days. The surgical procedure consisted of a standard pars plana vitrectomy and separation of the overlying artery from the vein using microscissors. In 16 cases dissection of the internal limiting membrane (ILM) in the macular area and around the AV crossing was also performed. Assessment of visual acuity, fluorescein angiography, and multifocal electroretinography were performed preoperatively and 6 weeks after surgery in seven patients.


RESULTS
Surgical procedure and postoperative course were uneventful. In most of the treated eyes visual acuity improved and fluorescein angiography revealed capillary reperfusion. Functional results in patients with AV decompression were highly significantly better than in the control group. Furthermore, removal of the ILM seems to have an additional beneficial effect on the functional outcome.


CONCLUSIONS
These results demonstrate the therapeutic effect of surgical AV decompression in BRVO. Additional removal of the ILM seems to improve the functional results. Further experience may answer some open questions.
Mester
Ulrich
U
Department of Ophthalmology, Bundesknappschaft's Hospital, An der klinik 10, 66280 Sulzbach, Germany.
Dillinger
Patrick
P
D000368:Aged; D001485:Basement Membrane / Q000601:surgery; D019299:Decompression, Surgical; D004596:Electroretinography; D005260:Female; D005451:Fluorescein Angiography; D006438:Hemodilution / Q000379:methods; D006801:Humans; D008297:Male; D012161:Retinal Artery / Q000601:surgery*; D012169:Retinal Vein / Q000601:surgery*; D012170:Retinal Vein Occlusion / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D016896:Treatment Outcome; D014792:Visual Acuity; D014821:Vitrectomy