Transvitreal limited arteriovenous-crossing manipulation without vitrectomy for complicated branch retinal vein occlusion using 25-gauge instrumentation.
OBJECTIVE
To evaluate a new technique, 25-gauge transvitreal limited arteriovenous-crossing manipulation without vitrectomy (LAM), for the treatment of branch retinal vein occlusion (BRVO) complicated by macular hemorrhage and/or macular edema recalcitrant to grid laser photocoagulation.


METHODS
Twelve eyes of 12 patients underwent LAM for BRVO performed by a single surgeon (M.S.H.) using the 25-gauge nitinol flexible-extendable blunt pick. The presence or absence of intraoperative reperfusion visualization, pre- and postoperative visual acuity, macular thickness as measured by optical coherence tomography, intraocular pressure, and lens status were evaluated.


RESULTS
Restoration of blood flow was noted in all patients and was based on intraoperative reestablishment of a red column of erythrocytes through the previously closed vessel. Mean visual acuity improved from 20/200 (logarithm of the minimal angle of resolution [LogMAR] +/- SD, 1.00 +/- 0.32) preoperatively to 20/70 (LogMAR +/- SD, 0.56 +/- 0.28) (P = 0.0003) at the final visit. Eleven (92%) of 12 eyes had >or=2 lines of visual improvement. Five eyes (45%) had final visual acuity of 20/50 or better. Mean macular thickness +/- SD improved from 401.0 +/- 73.2 to 178.7 +/- 19.6 microm (P < 0.0001) at the final visit. No statistically significant difference was noted in cataract progression or intraocular pressure. Mean follow-up +/- SD was 49.9 +/- 19.6 weeks. All patients were observed for at least 12 weeks.


CONCLUSIONS
LAM may achieve outcomes comparable with those of arteriovenous adventitial sheathotomy for complicated BRVO.
Lakhanpal
Rohit R
RR
Microsurgery Advanced Design Laboratory, Doheny Retina Institute, Doheny Eye Institute, Department of Ophthalmology, Keck School of Medicine, University of Southern California, Los Angeles 90033, USA.
Javaheri
Michael
M
Ruiz-Garcia
Humberto
H
De Juan
Eugene
E
Humayun
Mark S
MS
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003238:Connective Tissue / Q000473:pathology / Q000601:surgery*; D005260:Female; D005451:Fluorescein Angiography; D006801:Humans; D008269:Macular Edema / Q000150:complications / Q000175:diagnosis / Q000601:surgery; D008297:Male; D008875:Middle Aged; D013508:Ophthalmologic Surgical Procedures / Q000295:instrumentation; D012039:Regional Blood Flow; D012161:Retinal Artery; D012166:Retinal Hemorrhage / Q000150:complications / Q000175:diagnosis / Q000601:surgery; D012169:Retinal Vein; D012170:Retinal Vein Occlusion / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D041623:Tomography, Optical Coherence; D014792:Visual Acuity; D014821:Vitrectomy