Pars plana vitrectomy, internal limiting membrane peeling, and panretinal endophotocoagulation for macular edema secondary to central retinal vein occlusion

Abstract

Purpose: To investigate the visual and anatomic outcomes in eyes with cystoid macular edema (CME) resulting from central retinal vein occlusion (CRVO) that underwent pars plana vitrectomy, internal limiting membrane peeling, and panretinal endolaser photocoagulation (PPV/MP/EL).

Design: Retrospective, observational case series.

Methods: Consecutive, nonrandomized patients at the Duke Eye Center who underwent PPV/MP/EL for treatment of CME secondary to CRVO by a single surgeon (S.F.) over the last 5 years were identified and reviewed. Outcome measures include best-corrected visual acuity (BCVA), foveal thickness, and total macular volume (TMV).

Results: Twelve patients were identified. Duration of CRVO before surgery ranged from 3 to 19 months (mean, 12.3 months). Preoperative perfusion status was not ischemic in 6 eyes, ischemic in 5 eyes, and indeterminate in 1 eye. Intravitreal triamcinolone had been administered in 66% and was given at least 4 months before surgical intervention. After surgery, foveal thickness and TMV improved, but BCVA demonstrated only a modest improvement that did not reach statistical significance. At the time of surgery, 50% of eyes were pseudophakic. Of the remaining eyes, visually significant cataracts developed in all 6 (100%) within 1 year after surgery, with 67% of those undergoing cataract extraction within 15 months after PPV/MP/EL.

Conclusions: PPV/MP/EL performed for CME secondary to CRVO reduced foveal thickness and TMV at final follow-up; however, anatomic improvement did not correlate with a statistically significant improvement in BCVA.