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José García-Arumí, MD; Anna Boixadera, MD; Vicente Martinez-Castillo, MD; Reinaldo Castillo, MD; Antonio Dou, MD; Borja Corcostegui, MD

Arch Ophthalmol. 2003;121:1385-1391.

Objectives  To evaluate the incidence of chorioretinal anastomosis after radial optic neurotomy and to determine its effect on visual acuity and foveal thickness in patients with central retinal vein occlusion.

Methods  We conducted a prospective, uncontrolled, interventional study of 14 patients with preoperative visual acuities below 20/125. Pars plana vitrectomy and radial optic neurotomy were performed. Fluorescein angiography and optical coherence tomography were used to monitor the evolution of macular edema.

Results  All patients underwent radial optic neurotomy with no major complications. Eight patients (57.1%) gained 1 or more lines of visual acuity while the visual acuity of 6 patients (42.9%) improved by 2 or more lines (mean visual acuity, 20/80; P<.001) (mean visual acuity gain, 3 lines). The decrease in macular thickness was shown to be statistically significant (P<.001) (median, 282 µm). Retinochoroidal shunts developed in 6 eyes (42.9%) at the site of the radial optic neurotomy.

Main Outcome Measures  Improvement in visual acuity and a decrease in foveal thickness seen on optical coherence tomography.

Conclusions  Surgical decompression of central retinal vein occlusion via radial optic neurotomy seems to be a promising technique that improves or at least stabilizes the course of severe central retinal vein occlusion. Improvement may occur because of optic nerve decompression, vitrectomy, and by inducing new chorioretinal shunts that drain retinal circulation to the choroid and accelerate resolution of retinal edema.

From the Vall d'Hebrón Hospital, Universidad Autónoma de Barcelona (Drs García-Arumí, Boixadera, Martinez-Castillo, and Dou), and the Instituto de Microcirugía Ocular (Drs García-Arumí, Castillo, and Corcostegui), Barcelona, Spain. The authors have no relevant financial interest in this article.

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