ABSTRACT

REVS for CRVO, HRVO and AION

Jeffrey N. Weiss, M.D.

Retina Associates of South Florida

Margate, Fl 33063

RetinaAssocSF@aol.com

 

Purpose:

Central Retinal Vein Occlusion (CRVO), Hemispheric Retinal Vein Occlusion (HRVO) and Nonarteritic Anterior Ischemic Optic Neuropathy (NAION) may lead to severe visual loss. In the first follow-up year of the Central Vein Occlusion Study Group M report, only 6% of eyes recovered ³ 3 lines of vision and 0% recovered ³ 8 lines of vision. The natural history of NAION reported by the Ischemic Optic Neuropathy Decompression Trial Research Group demonstrated that 42.7% of eyes spontaneously recover ³ 3 lines of vision. Retinal Endovascular Surgery (REVS) is a vitrectomy followed by the cannulation of a retinal vein for CRVO and HRVO and a retinal artery for NAION with the injection of tissue plasminogen activator.

 

Methods:

In this prospective consecutive case series, 150 patients with CRVO, 20 with HRVO and 5 with AION of more than 1week duration and visual acuity of 20/50 or worse were offered REVS. The main outcome measure was the recovery of visual acuity.

 

Results:

The mean CRVO duration was 4 months (median 2 months), and the average preoperative acuity was 20/500 (88% were £ 20/200). Ninety-seven eyes (65%) were nonperfused or of indeterminate perfusion by fluorescein angiography and 19 eyes (13%) had anterior segment neovascularization (ASN). For HRVO, the mean duration was 4 months (median 3 months), and the average preoperative visual acuity was 20/250 (75% were £ 20/200). The mean NAION duration was 7 weeks (median 3 weeks), and the average preoperative acuity was 10/200 (80% were £ 20/200). The average postoperative follow-up was 1 year.

For CRVO, 78 eyes (52%) recovered ³ 3 lines of acuity, 42 (28%) recovered ³ 6 lines, and 21 (14%) recovered ³ 8 lines; the rates of ³ 3, ³ 6, and ³ 8 line recovery for HRVO were 65%, 40%, and 20%, respectively. 50% of the NAION patients gained 6.2 lines of acuity. Complications were macular edema (14%), vitreous hemorrhage (13%), the progression or development of ASN (9%), retinal detachment (4%), and macular hole (1%).

 

Conclusion:

REVS promotes visual recovery in excess of spontaneous improvement rates in CRVO and NAION and may promote visual recovery in HRVO.