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Laser-Induced Chorioretinal Venous Anastomosis for Treatment of Nonischemic Central Retinal Vein Occlusion

Laser-Induced Chorioretinal Venous Anastomosis for Treatment of Nonischemic Central Retinal Vein... Abstract Objectives: To determine whether a chorioretinal venous anastomosis could be created in humans and to evaluate the influence this has on patients with non-ischemic central retinal vein occlusions in whom progressive visual loss developed. Design: Retrospective study. Patients: A total of 24 patients with nonischemic central retinal vein occlusions and progressive visual loss. Intervention: An attempt was made to create a chorioretinal venous anastomosis using laser photocoagulation to enable obstructed venous blood to enter the choroid, thus bypassing the site of occlusion. Main Outcome Measures: Visual acuity, fundoscopic appearance, and rapid sequence fluorescein angiograms. Results: A successful chorioretinal venous anastomosis was created in eight cases (33%), with improvement in visual acuity and resolution of the funduscopic appearance of venous occlusion in all eight cases. Of the 16 patients (67%) in whom an anastomosis was not successfully created, the ischemic form of central retinal vein occlusion developed in five (31%), and eight (50%) were left with various degrees of macular damage and reduced visual acuity. Conclusions: Peripheral chorioretinal venous anastomoses can be created in a nonischemic central retinal vein occlusion and appear to be well tolerated. This technique may have some value in the treatment of patients with this condition; however, to address this fully, a properly constructed randomized prospective clinical trial will need to be performed. References 1. Green WR, Chan CC, Hutchins GM, Terry JM. Central retinal vein occlusion: a prospective histological study of 29 eyes in 28 cases . Trans Am Ophthalmol Soc . 1981;89:371-422. 2. Vasco-Posada J. Modification of the circulation in the posterior pole of the eye . Ann Ophthalmol . 1972;4:48-59. 3. Arciniegas A. Treatment of the occlusion of the central retinal vein by section of the posterior ring . Ann Ophthalmol . 1984;16:1081-1086. 4. Duff IF, Falls HF, Linman JW. Anticoagulant therapy in occlusive vascular disease of the retina . Arch Ophthalmol . 1951;46:601-615.Crossref 5. Vannas S, Orma H. Experience of treating retinal venous occlusion with anticoagulant and antisclerosis therapy . Arch Ophthalmol . 1957;58:812-828.Crossref 6. Kohner EM, Pettit JE, Hamilton AM, Bulpitt CJ, Dollery CT. Streptokinase in central retinal vein occlusions: a controlled clinical trial . BMJ . 1976;1:550-553.Crossref 7. Radnot M, Follmann P. Rheomacrodex (dextran) in treatment of the occlusions of the central retinal vein . Ann Ophthalmol . 1969;1:58-64. 8. Gombos GM. Retinal vascular occlusions and their treatment with low molecular weight dextran and vasodilators: report of six years experience . Ann Ophthalmol . 1978;10:579-583. 9. Hansen LL, Danisevskis P, Arntz H, Hovener G, Wiederholt M. A randomised prospective study on treatment of central retinal vein occlusion by isovolaemic haemodilution and photocoagulation . Br J Ophthalmol . 1985;69:108-116.Crossref 10. Hansen LL, Wiek J, Wiederholt M. A randomised prospective study of treatment of nonischemic central retinal vein occlusion by isovolaemic haemodilution . Br J Ophthalmol . 1989;73:895-899.Crossref 11. McAllister IL, Yu D-Y, Vijayasekaran S, Barry C, Constable IJ. Induced chorioretinal venous anastomosis in experimental retinal branch vein occlusion . Br J Ophthalmol . 1992;76:615-620.Crossref 12. Vijayasekaran S, Yu D-Y, McAllister IL, Barry C, Constable IJ. Significance of Bruch's members in the creation of iatrogenic chorioretinal venous anastomosis . Curr Eye Res . 1993;13:29-33.Crossref 13. Minturn J, Brown GC. Progression of non-ischemic central retinal vein obstruction to the ischemic variant . Ophthalmology . 1986;93:1158-1162.Crossref 14. Hayreh SS, van Heuven AJ, Hayreh MS. Experimental retinal vascular occlusion, I: pathogenesis of central retinal vein occlusion . Arch Ophthalmol . 1978;96:311-323.Crossref 15. Hesbery RJ. X-ray treatment of thrombosis of the retinal vein and several types of iridocyclitis . Am J Ophthalmol . 1944;27:864-875. 16. Clements DB, Elsby JM, Smith WD. Retinal vein occlusion: a co-operative study of factors affecting the prognosis, including a therapeutic trial of Atromid-S in this condition . Br J Ophthalmol . 1968;52:111-116.Crossref 17. Vannas S, Raitta C. Anticoagulant treatment of retinal venous occlusion . Am J Ophthalmol . 1966;62:874-881. 18. Oncel M, Peyman GA, Khoobehi B. Tissue plasminogen activator in the treatment of experimental retinal vein occlusion . Retina . 1989;9:1-7.Crossref 19. Schatz H, Green WR, Talamo JH, Hoyt WF, Johnson RN, McDonald HR. Clinicopathologic correlation of retinal to choroidal venous collaterals of the optic nerve head . Ophthalmology . 1991;98:1287-1293.Crossref 20. Priluck IA, Robertson DM, Hollenhorst RW. Long-term follow up of occlusion of the central retinal vein in young adults . Am J Ophthalmol . 1980;90:190-202. 21. Quinlan PM, Elman MJ, Bhatt AK, Mardesich P, Enger C. The natural course of central retinal vein occlusion . Am J Ophthalmol . 1990;110:118-123. 22. Zegarra H, Gutman FA, Zakov N, Carin M. Partial occlusion of the central retinal vein . Am J Ophthalmol . 1983;96:330-337. 23. Zegarra H, Gutman FA, Conforto J. The natural course of central retinal vein occlusion . Ophthalmology . 1979;86:1931-1939.Crossref 24. Central Vein Occlusion Group. Baseline and early natural history report: the Central Vein Occlusion Study . Arch Ophthalmol . 1993;111:1087-1095.Crossref 25. Chopdar A. Dual trunk central retinal vein incidence in clinical practice . Arch Ophthalmol . 1984;102:85-87.Crossref 26. Ryan SJ. The development of an experimental model of subretinal neovascularisation in disciform macular degeneration . Trans Am Ophthalmol Soc . 1979;77:707-745. 27. Archer DB, Gardiner TA. Morphologic, fluorescein angiographic and light microscopic features of experimental choroidal neovascularisation . Am J Ophthalmol . 1981;91:297-311. 28. Michels RG, Gass JD. The natural course of retinal branch vein obstruction . Trans Am Acad Ophthalmol Otolaryngol . 1974;78:166-177. 29. Branch Vein Occlusion Study Group. Argon laser photocoagulation for macular edema in branch vein occlusion . Am J Ophthalmol . 1984;98:271-282. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Ophthalmology American Medical Association

Laser-Induced Chorioretinal Venous Anastomosis for Treatment of Nonischemic Central Retinal Vein Occlusion

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References (31)

Publisher
American Medical Association
Copyright
Copyright © 1995 American Medical Association. All Rights Reserved.
ISSN
0003-9950
eISSN
1538-3687
DOI
10.1001/archopht.1995.01100040072030
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Abstract

Abstract Objectives: To determine whether a chorioretinal venous anastomosis could be created in humans and to evaluate the influence this has on patients with non-ischemic central retinal vein occlusions in whom progressive visual loss developed. Design: Retrospective study. Patients: A total of 24 patients with nonischemic central retinal vein occlusions and progressive visual loss. Intervention: An attempt was made to create a chorioretinal venous anastomosis using laser photocoagulation to enable obstructed venous blood to enter the choroid, thus bypassing the site of occlusion. Main Outcome Measures: Visual acuity, fundoscopic appearance, and rapid sequence fluorescein angiograms. Results: A successful chorioretinal venous anastomosis was created in eight cases (33%), with improvement in visual acuity and resolution of the funduscopic appearance of venous occlusion in all eight cases. Of the 16 patients (67%) in whom an anastomosis was not successfully created, the ischemic form of central retinal vein occlusion developed in five (31%), and eight (50%) were left with various degrees of macular damage and reduced visual acuity. Conclusions: Peripheral chorioretinal venous anastomoses can be created in a nonischemic central retinal vein occlusion and appear to be well tolerated. This technique may have some value in the treatment of patients with this condition; however, to address this fully, a properly constructed randomized prospective clinical trial will need to be performed. References 1. Green WR, Chan CC, Hutchins GM, Terry JM. Central retinal vein occlusion: a prospective histological study of 29 eyes in 28 cases . Trans Am Ophthalmol Soc . 1981;89:371-422. 2. Vasco-Posada J. Modification of the circulation in the posterior pole of the eye . Ann Ophthalmol . 1972;4:48-59. 3. Arciniegas A. Treatment of the occlusion of the central retinal vein by section of the posterior ring . Ann Ophthalmol . 1984;16:1081-1086. 4. Duff IF, Falls HF, Linman JW. Anticoagulant therapy in occlusive vascular disease of the retina . Arch Ophthalmol . 1951;46:601-615.Crossref 5. Vannas S, Orma H. Experience of treating retinal venous occlusion with anticoagulant and antisclerosis therapy . Arch Ophthalmol . 1957;58:812-828.Crossref 6. Kohner EM, Pettit JE, Hamilton AM, Bulpitt CJ, Dollery CT. Streptokinase in central retinal vein occlusions: a controlled clinical trial . BMJ . 1976;1:550-553.Crossref 7. Radnot M, Follmann P. Rheomacrodex (dextran) in treatment of the occlusions of the central retinal vein . Ann Ophthalmol . 1969;1:58-64. 8. Gombos GM. Retinal vascular occlusions and their treatment with low molecular weight dextran and vasodilators: report of six years experience . Ann Ophthalmol . 1978;10:579-583. 9. Hansen LL, Danisevskis P, Arntz H, Hovener G, Wiederholt M. A randomised prospective study on treatment of central retinal vein occlusion by isovolaemic haemodilution and photocoagulation . Br J Ophthalmol . 1985;69:108-116.Crossref 10. Hansen LL, Wiek J, Wiederholt M. A randomised prospective study of treatment of nonischemic central retinal vein occlusion by isovolaemic haemodilution . Br J Ophthalmol . 1989;73:895-899.Crossref 11. McAllister IL, Yu D-Y, Vijayasekaran S, Barry C, Constable IJ. Induced chorioretinal venous anastomosis in experimental retinal branch vein occlusion . Br J Ophthalmol . 1992;76:615-620.Crossref 12. Vijayasekaran S, Yu D-Y, McAllister IL, Barry C, Constable IJ. Significance of Bruch's members in the creation of iatrogenic chorioretinal venous anastomosis . Curr Eye Res . 1993;13:29-33.Crossref 13. Minturn J, Brown GC. Progression of non-ischemic central retinal vein obstruction to the ischemic variant . Ophthalmology . 1986;93:1158-1162.Crossref 14. Hayreh SS, van Heuven AJ, Hayreh MS. Experimental retinal vascular occlusion, I: pathogenesis of central retinal vein occlusion . Arch Ophthalmol . 1978;96:311-323.Crossref 15. Hesbery RJ. X-ray treatment of thrombosis of the retinal vein and several types of iridocyclitis . Am J Ophthalmol . 1944;27:864-875. 16. Clements DB, Elsby JM, Smith WD. Retinal vein occlusion: a co-operative study of factors affecting the prognosis, including a therapeutic trial of Atromid-S in this condition . Br J Ophthalmol . 1968;52:111-116.Crossref 17. Vannas S, Raitta C. Anticoagulant treatment of retinal venous occlusion . Am J Ophthalmol . 1966;62:874-881. 18. Oncel M, Peyman GA, Khoobehi B. Tissue plasminogen activator in the treatment of experimental retinal vein occlusion . Retina . 1989;9:1-7.Crossref 19. Schatz H, Green WR, Talamo JH, Hoyt WF, Johnson RN, McDonald HR. Clinicopathologic correlation of retinal to choroidal venous collaterals of the optic nerve head . Ophthalmology . 1991;98:1287-1293.Crossref 20. Priluck IA, Robertson DM, Hollenhorst RW. Long-term follow up of occlusion of the central retinal vein in young adults . Am J Ophthalmol . 1980;90:190-202. 21. Quinlan PM, Elman MJ, Bhatt AK, Mardesich P, Enger C. The natural course of central retinal vein occlusion . Am J Ophthalmol . 1990;110:118-123. 22. Zegarra H, Gutman FA, Zakov N, Carin M. Partial occlusion of the central retinal vein . Am J Ophthalmol . 1983;96:330-337. 23. Zegarra H, Gutman FA, Conforto J. The natural course of central retinal vein occlusion . Ophthalmology . 1979;86:1931-1939.Crossref 24. Central Vein Occlusion Group. Baseline and early natural history report: the Central Vein Occlusion Study . Arch Ophthalmol . 1993;111:1087-1095.Crossref 25. Chopdar A. Dual trunk central retinal vein incidence in clinical practice . Arch Ophthalmol . 1984;102:85-87.Crossref 26. Ryan SJ. The development of an experimental model of subretinal neovascularisation in disciform macular degeneration . Trans Am Ophthalmol Soc . 1979;77:707-745. 27. Archer DB, Gardiner TA. Morphologic, fluorescein angiographic and light microscopic features of experimental choroidal neovascularisation . Am J Ophthalmol . 1981;91:297-311. 28. Michels RG, Gass JD. The natural course of retinal branch vein obstruction . Trans Am Acad Ophthalmol Otolaryngol . 1974;78:166-177. 29. Branch Vein Occlusion Study Group. Argon laser photocoagulation for macular edema in branch vein occlusion . Am J Ophthalmol . 1984;98:271-282.

Journal

Archives of Ophthalmology – American Medical Association

Published: Apr 1, 1995

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