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Radial optic neurotomy for management of hemicentral retinal vein occlusion.

Garcia-Arumi J, Boixadera A, Martinez-Castillo V, Blasco H, Lavaque A, Corcostegui B

Hospital Vall d'Hebron and Instituto de Microcirugia Ocular, Universidad Autonoma de Barcelona, C/Munner no. 10, 08022 Barcelona, Spain. 17215jga@comb.es

OBJECTIVE: To evaluate the effect of radial optic neurotomy on visual acuity (VA) and foveal thickness in patients with hemicentral retinal vein occlusion. METHODS: A prospective noncomparative case series of 13 eyes in 13 patients with hemicentral retinal vein occlusion and a preoperative VA of 20/60 or less from a total of 232 retinal vein occlusions diagnosed. All patients underwent pars plana vitrectomy, posterior hyaloid dissection, and radial optic neurotomy at the nasal border of the optic disc. RESULTS: Visual acuity and macular thickness were measured with optical coherence tomography. Nine patients (69.2%) gained 2 or more Snellen lines of vision, and in 4 patients (30.8%) VA improved by 4 or more Snellen lines (median visual acuity, 20/50; mean VA, 20/45; P<.01) (average gain, 2.7 Snellen lines). The decrease in foveal thickness was statistically significant (P<.01) (median decrease, 297 microm). Final VA was statistically related to decreased macular thickness at optical coherence tomography (P = .03; rho = -0.62). Retinochoroidal shunts developed in 6 patients (46.1%) at the radial optic neurotomy site. No surgical complications were observed. CONCLUSIONS: Radial optic neurotomy seems to be a potential treatment in selected patients with hemicentral retinal vein occlusion, probably because of the more rapid appearance of retinochorioretinal collateral vessels, which promote faster resolution of macular edema.

Published 9 May 2006 in Arch Ophthalmol, 124(5): 690-5.
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