Early Experience with the Surgical Decompression of the Vein in the BranchRetinal Occlusion

Overview

Due to the development of the armamentarium and surgical techniques, theindications of pars plana vitrectomy (PPV) are expanding. It concerns also a relatively new indication, as is the branch retinal vein occlusion (BRVO) of thetemporal part of the posterior pole of the retina with the secondary involvementof the macular region.The purpose of this prospective study is to demonstrate anatomical andfunctionalresults after the surgical decompression of the occlusion of the branch retinalvein draining the macular region. Since November 1999, 3 patients, one womanand 2 men (age 70, 47 and 76 years) with the quadrant BRVO of the temporal partof the retina involving the macular region were followed. The visual acuity beforethe surgery in all 3 patients was 6/36 (20/120 or 0.16) and the BRVO lasted for 3-5months. The patients were examined by slitlamp biomicroscopy, and the courseof the disease was documented by means of red-free fundus photographs as wellas fluorescein angiograms. In all three patients, PPV and the adventitial sheathotomy of the arteriovenous crossing (AVC) were performed. Surgical decompression of BRVO and reperfusion of the ischemic part of the retina was achieved byseparating the overlying arteriole from the venule at AVC. Neither per- nor postoperative complications were noted. In two patients, the visual acuity impro-ved to 6/12 (20/40 or 0.5), and in the last one stabilized at 1/9 (20/180 or 0.11). Theminimal follow-up period was 12 months. In conclusion, we recommend to performing this new type of delicate surgery procedure in individual cases on the basisof detailed biomicroscopial examination and fluorecein angiograms by an experienced vitreoretinal surgeon.

Key words:
surgical decompression of the retinal vein, adventitial sheathotomyof the arteriovenous crossing, branch retinal vein occlusion (BRVO), pars planavitrectomy (PPV)