R 501
Branch retinal vein occlusion  medical therapy or surgical approach
U. Mester
Introduction: Branch retinal vein occlusion (BRVO) is the second most common vascular disorder of the retina, after diabetic retinopathy. 50-75 % of patients suffer from severe decrease in visual acuity, 20-30 % develop vasoproliferations with complications. The natural history in eyes with a visual acuity of 0.1 or less is typically unfavourable.
Several medical and surgical strategies have been employed to treat BRVO, most of them remaining uncertain or effective only in preventing secondary deterioration due to vasoproliferation.
Methods and results: The effectivity of medical treatments as isovolemic hemodilution are still uncertain, fibrinolytic agents may lead to severe complications and have several contraindications.
Laser photocoagulation can be beneficial in some cases of macular edema and if vasoproliferation after ischemic BRVO occurs.
Laser chorioretinal anastomosis by intense focal argon laser treatment is discussed controversely. Cannulation of branch retinal venules is still experimental.
Most cases of BRVO occur at arteriovenous crossings where both vessels share a common adventitial sheath. After vitrectomy it is possible to cut this sheath and separate the arteriole from the underlying venule. First results with this technique are published. Personal experience confirms that sheathotomy can lead to substantial functional improvement in some cases.
Discussion: With regard to limited therapeutical alternatives, surgical decompression (sheathotomy) is a promising new form of treatment in BRVO. Prospective, controlled clinical trials comparing the results with the natural course of BRVO or other treatment modalities in a greater number of patients are needed.
Department of Ophthalmology, Bundesknappschaft´s Hospital, An der Klinik 10, D-66280 Sulzbach