OBJECTIVES: To evaluate the incidence of chorioretinal anastomosis after radial optic neurotomy and to determine its effect on visual acuity and foveal thickness in patients with central retinal vein occlusion. METHODS: We conducted a prospective, uncontrolled, interventional study of 14 patients with preoperative visual acuities below 20/125. Pars plana vitrectomy and radial optic neurotomy were performed. Fluorescein angiography and optical coherence tomography were used to monitor the evolution of macular edema. RESULTS: All patients underwent radial optic neurotomy with no major complications. Eight patients (57.1%) gained 1 or more lines of visual acuity while the visual acuity of 6 patients (42.9%) improved by 2 or more lines (mean visual acuity, 20/80; P<.001) (mean visual acuity gain, 3 lines). The decrease in macular thickness was shown to be statistically significant (P<.001) (median, 282 microm). Retinochoroidal shunts developed in 6 eyes (42.9%) at the site of the radial optic neurotomy. MAIN OUTCOME MEASURES: Improvement in visual acuity and a decrease in foveal thickness seen on optical coherence tomography. CONCLUSIONS: Surgical decompression of central retinal vein occlusion via radial optic neurotomy seems to be a promising technique that improves or at least stabilizes the course of severe central retinal vein occlusion. Improvement may occur because of optic nerve decompression, vitrectomy, and by inducing new chorioretinal shunts that drain retinal circulation to the choroid and accelerate resolution of retinal edema.
OBJECTIVES: To evaluate the incidence of chorioretinal anastomosis after radial optic neurotomy and to determine its effect on visual acuity and foveal thickness in patients with central retinal vein occlusion. METHODS: We conducted a prospective, uncontrolled, interventional study of 14 patients with preoperative visual acuities below 20/125. Pars plana vitrectomy and radial optic neurotomy were performed. Fluorescein angiography and optical coherence tomography were used to monitor the evolution of macular edema. RESULTS: All patients underwent radial optic neurotomy with no major complications. Eight patients (57.1%) gained 1 or more lines of visual acuity while the visual acuity of 6 patients (42.9%) improved by 2 or more lines (mean visual acuity, 20/80; P<.001) (mean visual acuity gain, 3 lines). The decrease in macular thickness was shown to be statistically significant (P<.001) (median, 282 microm). Retinochoroidal shunts developed in 6 eyes (42.9%) at the site of the radial optic neurotomy. MAIN OUTCOME MEASURES: Improvement in visual acuity and a decrease in foveal thickness seen on optical coherence tomography. CONCLUSIONS: Surgical decompression of central retinal vein occlusion via radial optic neurotomy seems to be a promising technique that improves or at least stabilizes the course of severe central retinal vein occlusion. Improvement may occur because of optic nerve decompression, vitrectomy, and by inducing new chorioretinal shunts that drain retinal circulation to the choroid and accelerate resolution of retinal edema.