Management of retinal venous occlusion

The conservative treatment as well as photocoagulative therapy of central retinal and branch vein occlusion is reported on. In spite of encouraging reports in the literature on medical treatment with anticoagulants and antithrombocyte aggregation drugs, photocoagulation via the xenon-arc or argon-laser method should be preferred. The indication for photocoagulation depends on fluorescein angiographical controls with the ability to distinguish between reversible and irreversible retinal changes, thus assuming prognostic significance. In cases of central retinal vein occlusion one should begin with photocoagulation soon after the onset of the disease to prevent new vessel formation in the retina and iris with following vitreal hemorrhage and secondary angle-closure glaucoma. In cases of branch vein occlusion a more conservative approach with regular fluorescein angiographical controls are proposed, because the natural course and the prognosis without therapy will be good in most cases.

Xenon arc panretinal photocoagulation for central retinal vein occlusion: a randomised prospective study

Thirty-three patients with central vein occlusion were evaluated for the effects of scatter xenon arc panretinal photocoagulation. Thirty-four eyes (2 eyes of 1 patient) were randomly divided into a treatment (15 eyes) and a nontreatment group (19 eyes). The average follow-up per eye has been 29 months. The visual prognosis was not significantly better in either group. There was no difference in the development of fundus neovascularisation between groups. None of the patients in the treated group developed rubeosis or neovascular glaucoma. Two patients in the nontreatment group initially had rubeosis and 3 developed it after entry. All 5 involved eyes developed neovascular glaucoma. A significantly greater amount of central retinal capillary drop-out was present in the untreated eyes that developed rubeosis than those untreated eyes which did not. The eyes in the treated group had a similar range of capillary drop-out area, but none of these eyes developed rubeosis or neovascular glaucoma. Panretinal photocoagulation prevented the development of rubeosis and neovascular glaucoma in susceptible eyes.

The treatment of acute branch vein occlusion by photocoagulation

Twenty-eight eyes with retinal branch vein occlusion were treated by photocoagulation. The clinical posttreatment findings indicated rapid clearing of hemorrhages and exudates. Visual acuity in 12 (43%) eyes improved, in 11 (39%) remained static, and in five (18%) worsened.

The ocular aspects of bypass surgery of the carotid artery

A new neurosurgical procedure, anastomosis of the superficial temporal artery to the middle cerebral artery, is being performed with increasing frequency. Over a 7-year period (1971 through 1977), 121 patients have undergone this operation in our institution. Ophthalmodynamometry may be of great help in identifying occlusion of an internal carotid artery. Progressing venous stasis retinopathy and ischemic orbital pain are believed to be indications for bypass surgery of the carotid artery.

[Photocoagulation for central vein occlusion (author's transl)]

27 patients with fully developed central vein occlusion were treated by means of photocoagulation. In all cases, a relatively quick regression of retinal hemorrhage and retinal edema occurred, as well as an extensive nomalisation of the caliber of the veins. In over 1/3 of cases, improvement of visual acuity could be achieved; acuity decreased in 1/3 of cases because of macula alterations (fibrosis, cystic edema, pigmentary dystrophy). The results, however, showed a general improvement as compared to disease courses left untreated. None of the patients developed secondary glaucoma during case control which can be assessed as the most significant result of photocoagulation.

Retinal branch vein occlusion

Obstruction of a major temporal branch vein, or one of its macular tributaries, presents a significant threat to vision. Visual acuity may be reduced by macular edema or the consequences of retinal neovascularization, and these afflictions frequently become irreversible. Since the complicating macular edema and retinal neovascularization respond, at least in part, to argon laser therapy in some other conditions, some investigators have begun to treat branch vein occlusions with this modality. However, since the pathogenesis and natural history of the disorder have not yet been elucidated by prospective studies, it is not clear whether such treatment is indicated. Clinical and experimental studies are reviewed, and treatment rationale and techniques are discussed. The authors emphasize the need for well-controlled randomized studies to evaluate the natural history of branch vein occlusion and the efficacy of photocoagulation in its treatment.

Chorioretinal vascular anastomoses after perforating trauma to the eye

A 32-year-old white man sustained an ocular injury with a small piece of metal. He had perforation of the retina and choroid, and later developed chorioretinal vascular anastomosis. Disabling complications, such as neovascular growth, serous transudation, or hemorrhages, did not occur within a ten-month follow-up period. Interruption of Bruch's membrane and the retinal pigment epithelium, with approximation of the normally separated vasculatures of the choroid and retina, appears necessary for such anastomoses to occur.

The treatment of acute branch vein occlusion by photocoagulation

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Photocoagulation in retinal venous occlusion

Results of retinal photocoagulation therapy in 26 eyes with retinal branch vein occlusion (RBVO) and in 18 eyes with central retinal vein occlusion (CRVO) are presented. The final visual outcome in eyes with macular oedema (non-ischaemic type of occlusion) did not significantly differ from that reported in various untreated series of branch or central retinal vein occlusion. Neovascular complications in eyes with capillary non-perfusion (ischaemic type of occlusion) could not be prevented with the relatively mild photocoagulation technique (less than 200 xenon burns in CRVO) used in this study. On the basis of this series the value of photocoagulation therapy in improving the visual prognosis in venous occlusion is questionable, and, in order to prevent neovascular complications in the ischaemic type of occlusion, a more extensive treatment seems to be necessary.

[A contribution to the management of paracentral retinal branch vein obstruction (author's transl)]

11 eyes (11 patients) with cystoid macular edema secondary to central retinal branch vein occlusion were treated with Laser-coagulations. In 11 eyes macular edema disappeared completely. In 10 eyes visual acuity improved during the next months. One eye developed a macular hole with decrease of visual acuity. The results were compared with a group of 33 eyes (33 patients) which were treated with drugs. In 9 eyes visual acuity improved. In spite of the small number in this survey Laser-coagulation may be of value in the management of cystoid macular edema following retinal branch vein occlusion.

One hundred consecutive pars plana vitrectomies using the vitrophage

One hundred consecutive eyes underwent vitrectomy with the disposable vitrophage via a pars plana approach. Eyes were divided into two main categories based on opacity location-in the anterior or posterior segment. Patients with posterior segment opacities had diabetic retinopathy, nondiabetic vitreous hemorrhages, retinal detachments associated with vitreous hemorrhage, bands, or membranes, and intraocular foreign bodies or silicone oil. Patients with anterior segment opacities were treated for pupillary membranes resulting from surgical trauma or perforating injuries, and for complications following cataract extraction, such as capsule breakage and vitreous loss. Postoperatively, visual acuity improved in 68% of eyes with posterior segment opacities and in 85% of eyes with anterior segment opacities. Overall, visual acuity was 20/300 or better in 45% of eyes. There were only two intraoperative retinal tears and one postoperative rhegmatogenous retinal detachment.

Photocoagulation in venous occlusive disease

Fifty-one eyes with branch or tributary retinal venous occlusive disease underwent photocoagulation (1970-1973) after certain criteria were met: reduced visual acutity, fluorescein angiographic documentation of vessel permeability changes, and either dye leakage into the macula or neovascularization of the retina, or both. Eighty-four percent of the eyes responded to treatment with an improvement or stabilization in visual acuity, a reduction in collateral vessel caliber and permeability, and reduced dye accumlation in the macular area and increased fluorescein transit time. Photocoagulation is an affective means of reducing macular edema resulting from vascular compensatory changes following venous occlusion and decreases the risk of vitreous hemorrhage from sites of retinal neovascularization.