Surgical decompression of branch retinal vein occlusion via arteriovenous crossing sheathotomy: a prospective review of 15 cases

Abstract

Background: Branch retinal vein occlusion (BRVO), the second most common vascular disorder of the retina, typically occurs at arteriovenous (A/V) crossings where the arteriole and venule share a common adventitial sheath. Mechanical narrowing of the venous lumen at these intersections is thought to play a pathoetiologic role in BRVO.

Methods: We performed surgical decompression of BRVO via A/V crossing sheathotomy in 15 patients with decreased visual acuity due to macular hemorrhage, edema, and ischemia. Reperfusion of the retina was achieved by surgically separating the overlying retinal arteriole from the venule via vitrectomy and adventitial sheathotomy techniques.

Results: Intraoperative decompression of the A/V crossing was achieved in all 15 patients. All patients showed clinical improvement as determined by fundus examination, photography, and fluorescein angiography. Postoperative visual acuities were equal or improved in 80% of patients. Ten of the 15 subjects (67%) had improved visual acuity with an average gain of four lines of vision.

Conclusion: Surgical decompression of BRVO via A/V crossing sheathotomy is a technically feasible procedure that can result in rapid reperfusion of the retina. Resolution of macular hemorrhage, edema, and ischemia may improve visual prognosis in patients with this common retinal vascular disorder.