Combined arteriovenous sheathotomy and intraoperative intravitreal triamcinolone acetonide for branch retinal vein occlusion

Abstract

Purpose To describe the treatment of macular oedema secondary to branch retinal vein occlusion (BRVO) with concomitant pars plana vitrectomy/arteriovenous sheathotomy and intraoperative intravitreal triamcinolone acetonide. Methods Retrospective case series. Results Four eyes of four patients were identified. Patients improved from a mean best-corrected visual acuity of 20/124 at baseline to 20/122 at month 1, 20/83 at month 3, 20/74 at month 6, 20/59 at month 9 and 20/44 at month 12 (p¼0.01). All patients demonstrated improvement in visual acuity and macular oedema on fluorescein angiography and/or optical coherence tomography (OCT). Conclusion For patients with persistent macular oedema due to BRVO refractory to pharmacotherapy and/or laser photocoagulation, concomitant pars plana vitrectomy with arteriovenous sheathotomy and intravitreal triamcinolone may improve best-corrected acuity and reduce macular oedema on fluorescein angiography and OCT.Branch retinal vein occlusion (BRVO) is the second most prevalent retinovascular disease following diabetic retinopathy, and typically affects patients 50 years of age and older.1 BRVO usually has a favourable natural history, as approximately 60% of patients retain 20/40 vision or better.2 However, in many cases there is significant and sustained vision loss due to disease sequelae that include macular oedema, macular ischaemia, vitreous haemorrhage, secondary neovascularisation, serous retinal detachment, traction retinal detachment, traction-rhegmatogenous retinal detachment and capillary non-perfusion.3 A variety of treatment modalities have been explored, including laser photocoagulation, intraocular corticosteroid injections, limited arteriovenous-crossing manipulation without pars plana vitrectomy, pars plana vitrectomy alone, intravitreal injection of anti-vascular endothelial growth factor (VEGF) drugs and arteriovenous sheathotomy with or without pars plana vitrectomy.1e5 This report describes four patients who underwent vitrectomy and arteriovenous sheathotomy combined with intraoperative intravitreal triamcinolone acetonide for the treatment of persistent macular oedema due to BRVO. MATERIALS AND METHODSThe study adhered to the tenets of the Declaration of Helsinki and received approval by the institutional review board of New York Presbyterian Hospital (New York). Medical records of patients who underwent concomitant pars plana vitrectomy with arteriovenous sheathotomy and intraoperative intravitreal triamcinolone acetonide for the treatment of macular oedema due to BRVO from December 2002 to December 2008 at Columbia University Medical Center's Edward S Harkness Eye Institute were reviewed retrospectively in compliance with the Health Insurance Portability and Accountability Act. Data abstracted included patient demographics, ocular history and Snellen bestcorrected visual acuity (BCVA) immediately before surgery and at postoperative months 1, 3, 6, 9 and 12. Optical coherence tomography (OCT) and fluorescein angiography images were reviewed in an...

Zastosowanie laseroterapii w chorobach siatkówki. Część II

“…Stwierdzono, że zastosowanie miejscowo bromfenaku, niesteroidowego leku przeciwzapalnego, w oczach z obrzękiem plamki wtórnym do BRVO ma tę zaletę, że zmniejsza liczbę wstrzyknięć, chociaż nie wpływa na ostrość widzenia [26,34]. Inne badane terapie skojarzone to glikokortykosteroidy z laserem, preparaty anty-VEGF z glikokortykosteroidami, preparaty anty--VEGF z laserem i sheatotomia, czyli nacięcie pochewki naczyń (AVS) lub PPV z glikokortykosteroidami [26,[35][36][37][38][39][40][41][42][43]. Chociaż większość z tych badań wykazała doskonałe wyniki, trudno jest dokonać porównania między badaniami, aby ustalić, która kombinacja jest najlepsza [26].…”

Intravitreal Steroids

“…Consistently, Müller cell downregulation of Kir4. 1 and AQ4 was reported in animal models of retinopathies that frequently associate with ME, including diabetes [ 79 ], ocular infl ammation [ 80 , 81 ], and retinal venous occlusion [ 82 ]. Recently, intracellular edema of Müller cells has been described in ME, and it may be linked to the dysregulation of AQ4, which causes osmotic swelling of the cells [ 83 ], as well as to other factors such as the extravasation of albumin from leaky vessels (reviewed in [ 5 ]).…”

Current Treatment of Retinal Vein Occlusion

“…[140][141][142] Vitrectomy with sheathotomy has been combined with IVTA, showing favourable results of 1-3 Snellen lines for CRVO [143][144][145] and BRVO. 146,147 Vitrectomy with sheathotomy in combination with an injection of recombinant tissue plasminogen activator has also achieved VA recovery together with accelerated retinal haemorrhage reabsorption in the treatment of BRVO. 148 RON combined with vitrectomy and IVTA has also been described with improved VA and decreased central macular thickness.…”