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Abstract
Purpose
To evaluate the incidence of retinal choroidal collateral circulation after radial optic neurotomy (RON) with central retinal vein occlusion (CRVO) patients and to correlate these collaterals with changes in visual acuity.
Methods
We conducted a retrospective study of 17 eyes of 17 consecutive patients diagnosed with CRVO who underwent RON after a standard three port-vitrectomy. Fundus examination and, FAG were performed to evaluate the incidence of retinal choroidal collateral circulation according to preoperative best corrected visual acuity. We evaluated changes in best corrected visual acuity according to chorioretinal circulation formation.
Results
Retinochoroidal shunts developed in 9 eyes (52.9%) at the site of radial optic neurotomy. The group whose initial visual acuity was better than 0.02 (72.7%) developed more shunts than the group whose initial visual acuity was under 0.02 (16.7%) (P=0.043). Changes in visual acuity were highly correlated with the development of collaterals from the retinal to choroidal circulation (P=0.008).
Conclusions
Patients whose that initial visual acuity is better than 0.02 have more retinal choroidal collaterals. Surgical induction of retinochoroidal venous anastomosis may result in visual acuity improvement. Randomized studies are needed to compare the current study modality with the natural course of central retinal vein occlusion.
References
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Figure 1.
Chorioretinal collateral circulation formation correlated with the preoperative Best corrected visual acuity. P-value=0.043; * BCVA=best corrected visual acuity.
Figure 2.
Chorioretinal collateral circulation formation correlated with symptom duration. P-value=0.347.
Figure 3.
Case No 16. (A) Preoperative fundus view of the right eye of a 69-year-old man with central retinal vein occlusion. His preoperative BCVA* was 0.1. (B) In fluorescein angiography, flame-shaped retinal hemorrhage and macular edema was seen. (C) Fundus view 3 months later, Remained retinal hemorrhage and decreased macula edema was seen, also chorioretinal collateral circulation was formed (white arrow), His Postoperative BCVA* improved to 0.3. (D) Fluorescein angiography 3 months later, shows drainage of the retinal veins through the chorioretinal anastomosis. E) Fundus view. Thirty months later, Some dot like retinal hemorrhages were detected and chorioretinal collateral circulation formation was also seen (white arrow). His postoperative BCVA* was 0.3. (F) Fluorescein angiography 30 months later, Some chorioretinal scar was seen at macular area and chorioretinal collateral circulation formation was also seen; * BCVA=best corrected visual acuity.
Figure 4.
Scatter plot of preoperative and postoperative BCVA* with Central Retinal Vein Occlusion according to chorioretinal circulation formation. The Group A is the patients who deveoped chorioretinal collateral circulation and The Group B is the patients who did not deveoped chorioretinal collateral circulation. Hand movement corresponds to 0.001 and light perception to 0.0005, No light perception to 0. P-value=0.008; * BCVA=best corrected visual acuity.
Table 1.
Demorgaphic data for 17 patients with radial optic neurotomy for central retinal vein occlusion
| Case | Sex/Affected eye |
Symptom Duration (weeks) |
Retinal Ischemia |
BCVA* |
Collateral Circulation Formation |
Follow-up (months) |
IOP† Preop. (3 months) |
|
|---|---|---|---|---|---|---|---|---|
| Postop. |
Postop. (3 months) |
|||||||
| 1 | M/Left | 8 | No | FC50‡ | FC50 | No | 40 | 37 |
| 2 | F/Right | 1 | Yes | LP§ | NLP∏ | No | 15 | 15 |
| 3 | M/Right | 12 | No | HM# | NLP | No | 20 | 11 |
| 4 | F/Right | 2 | Yes | FC20 | HM | No | 4 | 29 |
| 5 | M/Right | 4 | No | 0.08 | 0.1 | No | 14 | 7 |
| 6 | M/Left | 8 | No | HM | LP | No | 8 | 38 |
| 7 | F/Right | 8 | Yes | 0.1 | 0.1 | No | 4 | 11 |
| 8 | F/Right | 3 | Yes | 0.02 | FC50 | No | 3 | 10 |
| 9 | M/Left | 8 | Yes | 0.02 | 0.3 | Yes | 40 | 11 |
| 10 | F/Left | 1 | Yes | FC50 | 0.04 | Yes | 3 | 13 |
| 11 | M/Right | 16 | No | 0.04 | 0.15 | Yes | 11 | 17 |
| 12 | F/Left | 2 | No | 0.1 | 0.3 | Yes | 3 | 11 |
| 13 | M/Right | 2 | Yes | 0.02 | 0.1 | Yes | 6 | 17 |
| 14 | M/Left | 8 | Yes | 0.02 | 0.04 | Yes | 3 | 7 |
| 15 | M/Left | 2 | No | 0.08 | 0.3 | Yes | 4 | 17 |
| 16 | F/Right | 2 | No | 0.1 | 0.3 | Yes | 32 | 20 |
| 17 | M/Left | 1 | No | 0.1 | 0.4 | Yes | 7 | 9 |
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