Management of macular edema in branch retinal vein occlusion with sheathotomy and recombinant tissue plasminogen activator.
OBJECTIVE
The common adventitial sheath that surrounds the retinal venule and arteriole at the crossing site plays a crucial role in branch retinal vein occlusion (BRVO). The purpose of this study was to report the surgical recanalization of the occluded vein using a bimanual technique and recombinant tissue plasminogen activator (tPA) and its effect on final visual acuity.


METHODS
Arteriovenous sheathotomy was performed, using a bimanual technique, followed by fluid-air exchange and injection of 25 mg of recombinant tPA over the area of the occluded vein.


RESULTS
Intraoperative sectioning of the common arteriovenous sheath was achieved in all 40 patients. Thrombus release was observed in 11 cases (27.5%) and was correlated with early surgery (P < 0.001) and better final visual recovery (P < 0.06). Optical coherence tomography showed macular thickness that decreased by greater than 40% in 31 patients (77.5%) compared with preoperatively, and correlated to postoperative visual acuity (P < 0.001). The mean visual acuity increased from 20/100 to 20/40, with 70% of patients gaining three or more lines of visual acuity (Pearson 0.378, P = 0.016).


CONCLUSIONS
Surgical venous decompression and injection of recombinant tPA may effectively manage macular edema secondary to BRVO, thus improving anatomic and visual outcome. Early surgical intervention may obtain maximum final visual recovery.
Hospital Vall d'Hebrón, Universidad Autónoma de Barcelona, Spain. 17215jga@comb.es
Jose
J
García-Arumí
Vicente
V
Martinez-Castillo
Ana
A
Boixadera
Hugo
H
Blasco
Borja
B
Corcostegui
D000328:Adult; D000368:Aged; D003131:Combined Modality Therapy; D019299:Decompression, Surgical; D005260:Female; D005451:Fluorescein Angiography; D006801:Humans; D008269:Macular Edema / Q000188:drug therapy / Q000209:etiology / Q000601:surgery / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011994:Recombinant Proteins / Q000627:therapeutic use; D012170:Retinal Vein Occlusion / Q000150:complications / Q000188:drug therapy / Q000601:surgery / Q000628:therapy*; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use*; D041623:Tomography, Optical Coherence; D014792:Visual Acuity; D014821:Vitrectomy
D011994:Recombinant Proteins; D010959:Tissue Plasminogen Activator