Sheathotomy in complicated cases of branch retinal vein occlusion.
OBJECTIVE
To report the clinical experience and results of using a microsurgical technique to decompress the arteriovenous connection in complicated branch retinal vein occlusion (BRVO) combined with haemorrhage, oedema and ischaemia.


METHODS
We carried out a retrospective, non-randomized, interventional case study of the surgical sheathotomy decompression procedure. We enrolled 12 patients (seven women, five men; median age 64 years) with BRVO and decreased visual acuity (VA) caused by haemorrhage, oedema and ischaemia. The mean duration of thrombosis was 7 months (2-15 months). The patients were examined for pre- and postoperative best corrected VA (BCVA), intraocular pressure (IOP) and fundus photography. Ten patients were examined with fluorescein angiography and eight with ocular coherence tomography (OCT). Postoperative progression of cataract was recorded, as were other complications. The mean follow-up time was 20 months (8-39 months).


RESULTS
Best corrected VA had improved in nine patients, was unchanged in one patient and had deteriorated in two patients at the last follow-up. Noted complications were venous haemorrhage at surgery in five patients, retinal detachment in one patient and progression of cataract in four patients.


CONCLUSIONS
Microsurgical treatment with sheathotomy of BRVO is a technically feasible procedure with few complications. Postoperative increased reperfusion could explain the resolution of macular haemorrhage, oedema and ischaemia, and may improve visual function in patients with this common vascular eye disease.
Crafoord
Sven
S
Department of Ophthalmology, Orebro University Hospital, Orebro, Sweden. sven.crafoord@orebroll.se
Karlsson
Niklas
N
la Cour
Morten
M
D000368:Aged; D002386:Cataract / Q000150:complications / Q000503:physiopathology; D019299:Decompression, Surgical / Q000009:adverse effects / Q000379:methods*; D018450:Disease Progression; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007511:Ischemia / Q000150:complications; D008266:Macula Lutea; D008269:Macular Edema / Q000150:complications / Q000175:diagnosis; D008297:Male; D008866:Microsurgery / Q000009:adverse effects / Q000379:methods; D008875:Middle Aged; D012163:Retinal Detachment / Q000209:etiology; D012164:Retinal Diseases / Q000150:complications*; D012166:Retinal Hemorrhage / Q000150:complications / Q000209:etiology; D012170:Retinal Vein Occlusion / Q000150:complications* / Q000503:physiopathology / Q000601:surgery*; D012171:Retinal Vessels; D012189:Retrospective Studies; D041623:Tomography, Optical Coherence; D014792:Visual Acuity