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No vision gain from lamina puncture in CRVO patients
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Performing a lamina puncture may not restore visual acuity to older patients suffering from central retinal vein occlusion, one study shows.
Lamina puncture is intended to “permit dilation of the obstructed central retinal vein into this newly created perivascular space, to dislodge the presumed thrombus present in the perilaminar location by the manipulation of the vessel, or both,” the study authors said.
Donald J. D’Amico, MD, and colleagues at Massachusetts Eye and Ear Infirmary evaluated the procedure’s efficacy in a non-randomized, interventional case series. The study included 20 consecutive patients — 12 men and 8 women — with a mean age of 72 years and 5.4 months’ mean duration of CRVO. Non-ischemic CRVO was first seen in 14 eyes, while 6 eyes had substantial ischemia, according to the study.
Surgeons performed all lamina puncture procedures during pars plana vitrectomy.
The researchers found that mean visual acuity did not change significantly from preop and remained in the counting fingers range. “Although 10 patients had some degree of visual improvement, only six had postoperative visual acuities of 20/200 or better and all but one of these were within 2 lines of their initial acuity,” the study authors said.
Patients also experienced numerous complications. Iris neovascularization, either alone or associated with neovascular glaucoma, vitreous hemorrhage, or both, developed in five eyes. Other complications included, rubeosis, retinal detachment, endophthalmitis, cataracts and macular edema.
“Only two patients seemed to have a convincing degree of central retinal vein perfusion at surgery and/or postoperatively, of whom the former achieved resolution of macular edema and a 20/80 result; the second case was complicated by postoperative endophthalmitis,” the authors said.
The study was published in Archives of Ophthalmology.