Arterio-venous dissection after isovolaemic haemodilution in branch retinal vein occlusion: a non-randomised prospective study.
OBJECTIVE
The rationale for this pilot study was to add arterio-venous dissection (AVD) after unsuccessful medical treatment in a well-defined group of patients with branch retinal vein occlusion (BRVO).


METHODS
In this prospective, interventional case series 35 consecutive patients with a visual acuity (VA) of 0.4 (logMar) or worse were scheduled for surgery within the first 3 months of the onset of BRVO. The study endpoint was VA 1 year after AVD. Secondary study endpoints were: correlation of VA and successful vessel dissection; complication rate; and number of additional surgical procedures within the first year of AVD.


RESULTS
Preoperative VA (logMar) was 0.82+/-0.05 (range 0.2-1.6). VA 6 weeks postoperatively was 0.54+/-0.06 (range 0-1.6), 3 months postoperatively 0.61+/-0.07 (0-1.56), 6 months postoperatively 0.74+/-0.08 (range 0-2) and 12 months postoperatively 0.55+/-0.07 (range 0.1-1.5). VA improved 1 year after AVD (p=0.0004). An improvement in VA did not depend on successful separation of the artery and the vein. Four patients had a retinal detachment, 19 patients needed cataract surgery within the first year of AVD. A total of 24 additional surgical procedures were needed.


CONCLUSIONS
Patients with BRVO may profit from AVD compared with a historical control group. Visual improvement was found irrespective of the successful dissection of vessels. The cataract formation rate and additional surgery was a shortcoming of the AVD procedure.
Feltgen
Nicolas
N
Department of Ophthalmology, University of Freiburg, Killianstrasse 5, 79106 Freiburg, Germany. nicolas.feltgen@uniklinik-freiburg.de
Herrmann
Julia
J
Agostini
Hansjuergen
H
Sammain
Adel
A
Hansen
Lutz L
LL
D000368:Aged; D003238:Connective Tissue / Q000601:surgery; D019299:Decompression, Surgical; D005260:Female; D006438:Hemodilution; D006801:Humans; D008269:Macular Edema / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D010865:Pilot Projects; D011183:Postoperative Complications; D011446:Prospective Studies; D012161:Retinal Artery / Q000601:surgery*; D012169:Retinal Vein / Q000601:surgery*; D012170:Retinal Vein Occlusion / Q000503:physiopathology / Q000601:surgery*; D016896:Treatment Outcome; D014792:Visual Acuity / Q000502:physiology; D014821:Vitrectomy