Angiographic findings in arteriovenous dissection (sheathotomy) for decompression of branch retinal vein occlusion.
BACKGROUND
Arteriovenous dissection (sheathotomy) is a new therapeutic option in patients with branch retinal vein occlusion (BRVO) and macular involvement. We present an angiographic follow-up of 22 patients who underwent arteriovenous dissection (AVD).


METHODS
Twenty-two patients (15 women; mean age 68.7+/-8.0 years) were examined preoperatively and 6 weeks, 3 months, 6 months, and 1 year after AVD. For assessment of retinal hemodynamics, arteriovenous passage time (AVP) of the affected and unaffected branches at first (AVPe) and at maximal (AVPmax) venous filling were measured. Changes in the foveal avascular zone (FAZ) were calculated to determine foveal structural changes. Visual acuity was assessed as functional parameter.


RESULTS
The early AVP (AVPe) of the affected branch increased from 4.4+/-0.8 s preoperatively to 4.9+/-0.6 s 6 weeks after surgery and decreased to 2.7+/-0.4 s 1 year after surgery (p=0.05). When compared to the unaffected control branch, AVPe was significantly increased in the affected branch preoperatively (4.5+/-0.8 s versus 1.5+/-0.2 s, p<0.01), 6 weeks (4.9+/-0.6 s versus 2.1+/-0.3 s, p<0.01), 3 months (2.7+/-0.4 s versus 1.5+/-0.2 s, p<0.01), and 6 months (3.1+/-0.4 s versus 2.2+/-0.3 s, p=0.02) after AVD. After 1 year, AVPe no longer differed between the affected and the control branch (2.7+/-0.4 s versus 2.6+/- 0.3 s). AVPmax was significantly increased in the affected branch preoperatively (11.8+/-0.8 s versus 7.7+/-1.0 s, p<0.05). The AVPmax in the affected branch with the exception of 3 months after surgery (10.2+/-1.1 s, p<0.01) was no longer elevated when compared to preoperative values. The area of the FAZ did not change significantly but showed a trend for enlargement.


CONCLUSIONS
AVD for decompression of BRVO leads to a significant decrease of AVP and may ameliorate retinal perfusion in the affected branch.
Kube
Thomas
T
Sektion Retinologie, Augenklinik, Universitätsklinikum Freiburg, Killianstr. 5, 79106, Freiburg, Germany. kube@aug.ukl.uni-freiburg.de
Feltgen
Nicolas
N
Pache
Mona
M
Herrmann
Julia
J
Hansen
Lutz Lothar
LL
D000368:Aged; D001783:Blood Flow Velocity; D003238:Connective Tissue / Q000601:surgery*; D019299:Decompression, Surgical / Q000379:methods*; D005260:Female; D005451:Fluorescein Angiography; D006801:Humans; D008297:Male; D013508:Ophthalmologic Surgical Procedures; D009887:Ophthalmoscopy; D012161:Retinal Artery / Q000502:physiology*; D012169:Retinal Vein / Q000502:physiology*; D012170:Retinal Vein Occlusion / Q000503:physiopathology / Q000601:surgery*; D014792:Visual Acuity
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