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Sheathotomie in Branch Retinal Vein Occlusion
Mester U.,
Bundesknappschaft Sulzbach/Saar, Augenklinik (Sulzbach/Saar)
Branch retinal vein occlusion (BRVO) is the second most vascular disorder of the retina. The only established risk factor is systemic hypertension. Our therapeutical armamentarium including isovolemic hemodilution is limited with uncertain efficacy. Laser treatment has only been proven to be effective in preventing neovascularisation and may improve macular function in certain cases. Today, the pathogenetic mechanism of BRVO is postulated to consist in compression of the vein by the sclerotic artery due to a common adventitial sheath at the arteriovenous crossing. This leads to downstream turbulence in the vein, endothelial damage, and secondary thrombosis in certain cases. Therefore already 1988 Osterloh and Charles saw the logical approach for the treatment of BRVO in a dissection of the adventitial sheath at the AV-crossing. Since August 1999 sheathotomy was offered to our patients with BRVO demonstrating deterioration of visual acuity to 0.4 or less, macular hemorrhages and edema or ischemia. Patients who refused surgery received isovolemic hemodilution for 10 days and served as control. Functional results in patients with AV-decompression were significantly better than in the control group. Fluorescein angiography revealed capillary reperfusion in 83 % after surgery. Multifocal ERG confirmed the restoration of macular function. Until June 2002, 102 eyes with BRVO were treated surgically. Meanwhile we routinely perform an additional ILM-removal in the macula and the area of the occluded vein. The ILM appeared thickened and firmly adherent to the retina in all cases. ILM-removal seems to accelerate the resorption of blood and macular edema. Our results with sheathotomy are still favourable and encouraging. A controlled multicenter study is on the way.