Laser-induced chorioretinal venous anastomosis for treatment of nonischemic central retinal vein occlusion

I. L. McAllister and I. J. Constable
Lions Eye Institute, Perth, Australia.

OBJECTIVES: To determine whether a chorioretinal venous anastomosis could be created in humans and to evaluate the influence this has on patients with nonischemic central retinal vein occlusions in whom progressive visual loss developed. DESIGN: Retrospective study. PATIENTS: A total of 24 patients with nonischemic central retinal vein occlusions and progressive visual loss. INTERVENTION: An attempt was made to create a chorioretinal venous anastomosis using laser photocoagulation to enable obstructed venous blood to enter the choroid, thus bypassing the site of occlusion. MAIN OUTCOME MEASURES: Visual acuity, funduscopic appearance, and rapid sequence fluorescein angiograms. RESULTS: A successful chorioretinal venous anastomosis was created in eight cases (33%), with improvement in visual acuity and resolution of the funduscopic appearance of venous occlusion in all eight cases. Of the 16 patients (67%) in whom an anastomosis was not successfully created, the ischemic form of central retinal vein occlusion developed in five (31%), and eight (50%) were left with various degrees of macular damage and reduced visual acuity. CONCLUSIONS: Peripheral chorioretinal venous anastomoses can be created in a nonischemic central retinal vein occlusion and appear to be well tolerated. This technique may have some value in the treatment of patients with this condition; however, to address this fully, a properly constructed randomized prospective clinical trial will need to be performed.

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