Collateral Vessel Formation After Radial Optic Neurotomy

Traynor, Matthew P.; Conway, Brian

doi:10.1097/00006982-200408000-00019

Cited by 5 publications

(4 citation statements)

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“…Third, new retinochoroidal shunts developed in 6 patients at the radial optic neurotomy site, creating a new venous outflow pathway. We believe the collateral vessels formed after neurotomy appear earlier and are more active in draining edema and hemorrhages than are those that appear spontaneously (this has been observed by several authors who have managed CRVO with radial optic neurotomy [7][8][9][10] ) or those created after laser application. 14 In addition, their location close to the optic nerve renders them more effective.…”

Section: Resultsmentioning

confidence: 63%

“…Radial optic neurotomy induced chorioretinal anastomosis in 41% of the patients after a mean of 6 weeks; this effect had been previously observed in pilot studies using this procedure in patients with CRVO. [7][8][9][10] To our knowledge, there is no report in the literature on the management of macular edema secondary to HCRVO with radial optic neurotomy, apart from an isolated case reported by Weizer et al 16 We believe that improvement in our patients may have occurred by means of different mechanisms. First, pro-posed mechanical pressure exerted on the hemicentral retinal vein in the optic nerve was relieved.…”

Section: Resultsmentioning

confidence: 72%

“…Opremcak et al 6 described radial optic neurotomy, that is, radial surgical sec-tion of the optic nerve head on the nasal border near the central retinal vein as well as the adjacent retina and peripapillary sclera, as a way to release proposed pressure on the scleral canal. It has been reported [7][8][9][10] that radial optic neurotomy also induces new retinochoroidal shunts at the site of the neurotomy that drain the retinal circulation to the choroid and accelerate the resolution of the retinal edema in cases of CRVO. Considering the similar nature of HCRVO and CRVO, the purpose of our study was to determine the visual results in patients with HCRVO and a preoperative visual acuity (VA) of 20/60 or worse treated with radial optic neurotomy and to determine the effects of radial optic neurotomy on macular edema.…”

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confidence: 99%

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Radial Optic Neurotomy for Management of Hemicentral Retinal Vein Occlusion

García-Arumí

Boixadera²,

Martínez-Castillo³

et al. 2006

Arch Ophthalmol

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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; PϽ.01) (average gain, 2.7 Snellen lines). The decrease in foveal thickness was statistically significant (PϽ.01) (median decrease, 297 µm). Final VA was statistically related to decreased macular thickness at optical coherence tomography (P = .03; = −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.

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Section: Resultsmentioning

confidence: 63%

Section: Resultsmentioning

confidence: 72%

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confidence: 99%

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Radial Optic Neurotomy for Management of Hemicentral Retinal Vein Occlusion

García-Arumí

Boixadera²,

Martínez-Castillo³

et al. 2006

Arch Ophthalmol

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“…Nomoto et al [59] fanden eine Verbesserung der retinalen Zirkulation in der Hälfte der Patienten nach RON, ebenfalls in Abhän-gigkeit von der Ausbildung chorioretinaler Anastomosen. Auch Traynor und Conway [80] beschreiben einen Fall mit Visusanstieg von 0,1 auf 0,4 nach RON mit Entwicklung einer Anastomose.…”

Section: Hämodilutionunclassified

Chirurgische Therapie retinaler Venenverschlüsse

Mester

2005

Klin Monatsbl Augenheilkd

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Retinal vein occlusions are the second most common vision threatening retinal vascular disorders. Our therapeutic armamentarium for functional improvement was very limited in the past for all types of retinal vein occlusions (branch, central and hemi-central retinal vein occlusion). Also pathomechanism and risk factors are not completely understood yet. Argon-laser-photocoagulation can prevent the development and treat neovascularizations successfully, but is unable to improve visual function in most cases. Thrombolytic therapy applied systemically is limited due to serious side effects but may be helpful when injected intraocularly. Isovolemic hemodilution may be efficacious in central retinal vein occlusion (CRVO). The creation of a laser-induced chorioretinal venous anastomosis showed serious complications. Since 1999 numerous reports on successful surgical techniques were published. It could be shown that the dissection of the adventitial sheath with separation of the artery from the vein at the arteriovenous crossing where branch retinal vein occlusion occurs can re-establish the retinal blood flow with reduction of macular edema. But it is still unclear which step of the surgery (vitrectomy, ILM-peeling, sheathotomy) is causative for the results. A new surgical approach in CRVO is the radial optic neurotomy (RON). This technique was primarily performed under the hypothesis of decompression of the central vein by cutting the scleral ring. Meanwhile there is some evidence that the formation of chorioretinal shunts may be the decisive factor in cases of successfully performed RON. Due to inconsistent and rare data this surgical procedure needs further evaluation. Another surgical option is the cannulation of the occluded vein. This technique seems to be feasible but the clinical results still have to be proved. Despite several uncertainties and open questions, surgical techniques are likely to overcome the desolate therapeutic situation for retinal vein occlusion of the past.

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Optical Coherence Tomography in the Diagnosis of Retinal Vascular Disease

Walsh

Sadda

Retinal Vascular Disease

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Collateral Vessel Formation After Radial Optic Neurotomy

Cited by 5 publications

References 3 publications

Radial Optic Neurotomy for Management of Hemicentral Retinal Vein Occlusion

Radial Optic Neurotomy for Management of Hemicentral Retinal Vein Occlusion

Chirurgische Therapie retinaler Venenverschlüsse

Optical Coherence Tomography in the Diagnosis of Retinal Vascular Disease

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