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New technique leads to safe removal of the embolus in retinal arterial occlusion

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VIENNA, Austria — A novel technique to surgically remove the embolus may be a better approach to retinal arterial occlusion, according to a pilot study presented at the Euretina Congress here.

Other methods such as Nd:YAG embolysis have shown limited effectiveness and a fairly high rate of complications.

The new approach proposed by José Garcia-Arumi, MD, has proven effective in nine of the 11 cases treated (82%).

"This method gives direct mechanical access to the site of obstruction, allows embolus removal from the artery and decreases the unpredictability of results of Nd:YAG laser embolysis," he said.

All treated patients had retinal arterial occlusion of less than 36 hours' duration. They underwent vitrectomy with posterior hyaloid dissection.

A 25-gauge microblade was used to perform a longitudinal dissection of the arteriole of a sufficient size to release the embolus. By using forceps, the embolus was then squeezed out of the arteriole.

"Bleeding occurs when the arterial wall is dissected, but as soon as the embolus is released, the wound closes and the bleeding stops almost immediately," Dr. Garcia-Arumi said. In three cases, delayed bleeding occurred but resolved spontaneously. In seven cases, arterial reperfusion was obtained.

"Surgical maneuvers may cause minor endothelial damage, but visual acuity improves remarkably," Dr. Garcia-Arumi said.

Following its natural course, retinal arterial occlusion leads to a considerable loss of visual acuity, ranging between counting fingers and light perception in 90% of the cases. The presence of an embolus is associated with a poorer prognosis. In Dr. Garcia-Arumi's case series, surgical removal of the embolus improved visual acuity from a median of 20/400 preop to 20/60 postop. In reperfused cases, the median postop visual acuity was 20/30.

"What we need now is to develop more specialized instruments. With a newly designed microblade, we were able to carry out surgery better with a more accurate cut and less bleeding," he noted.

A larger multicenter study of retinal arterial occlusion cases treated with this technique is expected to be under way soon.