SHEATHOTOMY FOR TREATMENT OF BRANCH RETINAL VEIN OCCLUSION

OBJECTIVE: To evaluate visual outcome after arteriovenous sheathotomy for the treatment ofbranch retinal vein occlusion (BRVO). DESIGN: A descriptive case review. SETTING: Civil Hospital and Dow University of Health Sciences, Karachi, Sindh - Pakistan. METHODS: A pars plana vitrectomy and dissection of the involved AV crossing site were performed consecutively in 20 eyes of 20 patients with BRVO and vision loss. The overlying retinal artery was dissected free from the retinal surface, and separation of the artery and vein at the crossing site was attempted. RESULTS: In 19 of 20 eyes, the retinal artery was dissected around the crossing site. After a mean follow-up of 10.5 months, VIA improved by at least two lines or more in 16 eyes (80%), remained unchanged in two eyes (10%), and worsened by at least two lines in two eyes ( 10%). Mean change (+/- SE) in logMAR acuity was -0.28 +/- 0.11; two or three lines of improvement (P=0.016) at 1 to 2 months' follow-up and -0.44 +/- 0.14; three or four lines of improvement (P = 0.008) at the final follow-up. Cataract formation or progression occurred in 88% cases. CONCLUSION: A surgically important adhesion between the retinal artery and vein at proximal AV crossings was encountered in all eyes undergoing AV sheathotomy. Cataract formation was a frequent complication. Visual improvement may occur after vitrectomy and AV sheathotomy without separation of the retinal vessels.