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Radial optic neurotomy improved vision in study of CRVO patients
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Performing radial optic neurotomy within 90 days of the onset of symptoms can improve vision in patients with central retinal vein occlusion, according to a study by German researchers.
"It is hypothesized that CRVO [central retinal vein occlusion] constitutes a neurovascular compartment syndrome at the site of the lamina cribrosa, which can be alleviated by performing a radial incision at the nasal part of the optic nerve head, relaxing the cribriform plate and the adjacent sclera," the authors said in the study.
Heike C. Hasselbach, MD, and colleagues at five centers investigated the efficacy of radial optic neurotomy in 107 eyes of 107 patients treated at a mean age of 68 years. They found that mean logMAR visual acuity improved from 0.05 preoperatively to 0.08 at 6 months mean follow-up. Also, eyes that showed severe peripapillary swelling of the optic nerve head preoperatively had an average VA increase of 4.2 lines, according to the study.
However, patients treated more than 90 days after the onset of CRVO showed no significant change in VA, the authors noted.
Investigators also observed angiographic findings of shunt vessels in 18 of 30 cases at 12 months follow-up, which were accompanied by an average six-line improvement in VA.
Overall, 86.8% of eyes showed various visual field defects, but only one patient (0.9%) suffered an iatrogenic injury to the central retinal artery, the authors reported.
"Despite the potential risk of visual field defects, [radial optic neurotomy] seems to be a quite safe procedure. The majority of patients showed rapid normalization of the morphologic fundus findings, with an improvement in VA uncommon for the natural history of CRVO," they wrote.
The study is published in the August issue of Graefe's Archive for Clinical and Experimental Ophthalmology.