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Case Reports
. 2016 Jan 8;7(1):1-8.
doi: 10.1159/000443322. eCollection 2016 Jan-Apr.

Pars Plana Vitrectomy Combined with Internal Limiting Membrane Peeling to Treat Persistent Macular Edema after Anti-Vascular Endothelial Growth Factor Treatment in Cases of Ischemic Central Retinal Vein Occlusion

Yukari Shirakata  1 , Tomoyoshi Fujita  1 , Yuki Nakano  1 , Fumio Shiraga  2 , Akitaka Tsujikawa  1
Affiliations
Case Reports

Pars Plana Vitrectomy Combined with Internal Limiting Membrane Peeling to Treat Persistent Macular Edema after Anti-Vascular Endothelial Growth Factor Treatment in Cases of Ischemic Central Retinal Vein Occlusion

Yukari Shirakata et al. Case Rep Ophthalmol. .

Abstract

Objective: To evaluate the efficacy of pars plana vitrectomy (PPV) combined with internal limiting membrane (ILM) peeling in cases of ischemic central retinal vein occlusion (CRVO) where macular edema (ME) persisted after anti-vascular endothelial growth factor (anti-VEGF) treatment.

Methods: Fifteen eyes with ischemic CRVO-related ME were included in the study. Nine were treated with panretinal photocoagulation after initial examination. Anti-VEGF agents were injected intravitreally. Persistent ME was treated with PPV combined with ILM peeling. During surgery, laser photocoagulation was further applied to the non-perfused area.

Results: Mean retinal thickness gradually decreased after surgery (p = 0.024 at 6 months), although visual acuity did not improve significantly during the follow-up period (14.7 ± 11.6 months). Neovascular glaucoma subsequently developed in three cases and a trabeculectomy was performed in one case.

Conclusion: In eyes with ischemic CRVO, PPV combined with ILM peeling contributed to a reduction in persistent ME. However, there was no significant improvement in visual acuity.

Keywords: Anti-vascular endothelial growth factor; Central retinal vein occlusion; Internal limiting membrane peeling; Macular edema; Pars plana vitrectomy.

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Figures

Fig. 1
Fig. 1
A 64-year-old man had decreased VA in the left eye (0.3 OS) due to ME caused by ischemic CRVO. a Fundus photograph at the initial visit showing extensive retinal hemorrhage. b Fluorescein angiogram showing a large non-perfused area. c–h Horizontal (left) and vertical (right) sectional images centered on the fovea were obtained by OCT. c OCT section at initial visit showing ME (CRT = 402 µm). d No reduction in ME was seen after an intravitreal injection of bevacizumab (CRT = 403 µm). There was also no improvement in VA (0.2 OS). Three months after the initial visit, the left eye was treated with PPV with ILM peeling. During surgery, laser photocoagulation was performed on the non-perfused area. e–h After surgery, ME decreased gradually, with no visual improvement. e One month after surgery (CRT = 484 µm, 0.1 OS). f Three months after surgery (CRT = 567 µm, 0.2 OS). g Six months after surgery (CRT = 456 µm, 0.2 OS). h Twelve months after surgery (CRT = 279 µm, 0.15 OS).
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