Radial optic neurotomy as treatment for central retinal vein occlusion

Abstract

Purpose: To review our initial experience with radial optic neurotomy as treatment for retinal vein occlusion.

Design: Interventional case series.

Patient population: five patients (four with central retinal vein occlusion and one with hemiretinal vein occlusion).

Intervention: Pars plana vitrectomy with radial optic neurotomy was performed in each case.

Main outcome measures: Best-corrected visual acuity, presence of macular edema, perfusion status, and time to venous phase of the angiogram were reviewed retrospectively.

Results: Mean preoperative visual acuity was 4/200. Preoperatively, the vein occlusion was perfused in one (20%), nonperfused in one (20%), and indeterminate in three (60%). Mean follow-up time was 4.5 months. Mean postoperative visual acuity was 20/400 at last follow-up. Four patients (80%) had improvement in visual acuity and one (20%) worsened. Two patients (40%) improved to 20/80 postoperatively. In four cases (80%), disk congestion improved and intraretinal hemorrhage reabsorbed more quickly than would be expected without treatment. Time to the venous phase of fluorescein angiography improved slightly in three cases (60%) postoperatively. Perfusion status as determined by fluorescein angiography was not significantly altered postoperatively. One patient (20%) had resolution of macular edema postoperatively as shown by volumetric optical coherence tomography. One patient developed choroidovitreal neovascularization and one developed iris neovascularization postoperatively, both of which responded to panretinal photocoagulation.

Conclusions: Radial optic neurotomy may improve visual acuity in eyes with central retinal vein occlusion, although choroidovitreal neovascularization from the neurotomy site can occur. Further study is needed to determine its role in the management of central vein occlusion.