Comparison of surgical treatments for central retinal vein occlusion; RON vs. cannulation of tissue plasminogen activator into the retinal vein.
OBJECTIVE
To compare the surgical outcomes and evaluate the effectiveness of two treatments for central retinal vein occlusion: radial optic neurotomy (RON) and cannulation of tissue plasminogen activator (tPA) into the retinal vein (tPA).


METHODS
This study consisted of 22 eyes. The inclusion criterion was a best-corrected visual acuity of < or =20/60 due to central retinal vein occlusion. The exclusion criteria were previous treatment and the presence of ocular neovascularization. Patients were randomized into RON or tPA groups (n = 11 each). Best-corrected visual acuity, macular thickness, and complications were recorded.


RESULTS
The mean best-corrected visual acuity changed from 16/200 at baseline to 20/167 at 12 months in RON (P = 0.217) and from 10/200 to 20/200 in tPA (P = 0.051). The preoperative macular thicknesses decreased from 1,059 microm to 406 microm 12 months postoperatively in RON (P < 0.001) and from 1,121 microm to 271 microm (P < 0.001) in tPA. Neovascular glaucoma developed in 2 eyes (18%) in RON and in 4 eyes (40%) in tPA. Visual field defects associated with surgery were seen in 2 eyes (18%) in RON.


CONCLUSIONS
There was no significant difference in surgical outcomes between the two procedures. Although best-corrected visual acuity and macular edema improved, the incidence of neovascular glaucoma was high. It is, therefore, still uncertain whether these treatments are effective.
Yamamoto
Takuhiro
T
Department of Ophthalmology, Osaka University Graduate School of Medicine, Suita, Japan.
Kamei
Motohiro
M
Sakaguchi
Hirokazu
H
Oshima
Yusuke
Y
Ikuno
Yasushi
Y
Gomi
Fumi
F
Ohji
Masato
M
Tano
Yasuo
Y
D000368:Aged; D002404:Catheterization; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage*; D015355:Glaucoma, Neovascular; D006801:Humans; D008266:Macula Lutea / Q000473:pathology; D008297:Male; D008875:Middle Aged; D013508:Ophthalmologic Surgical Procedures / Q000379:methods*; D011183:Postoperative Complications; D011446:Prospective Studies; D012169:Retinal Vein / Q000187:drug effects / Q000601:surgery; D012170:Retinal Vein Occlusion / Q000188:drug therapy / Q000473:pathology / Q000601:surgery*; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage*; D016896:Treatment Outcome; D014792:Visual Acuity
D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator