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Histopathologic Study in Human Cadaver Eyes

Michael M. Altaweel, MD; Lars Freisberg, MD; Nikhil Pal, MD; Joel Gleiser, MD; Edwin H. Ryan, MD; Daniel Dawson, MD; Daniel Albert, MD, MS

Arch Ophthalmol. 2007;125(11):1553-1557.

Objective  To examine the structural effect of radial optic neurotomy (RON) using nasal and temporal approach incisions on the nasal side of the optic nerve (ON) using dominant and nondominant hands in human cadaver eyes.

Methods  Transvitreal RON was performed in 9 eyes with a microvitreoretinal blade by a right-handed surgeon. A nasal approach was used in 4 left eyes (using the right hand) and in 2 right eyes (using the left hand), and a temporal approach was used in 3 right eyes (using the right hand). Histologic sections were examined for depth of nerve penetration and for effect on critical structures.

Results  The scleral canal was fully incised in all cases. The mean depth of nerve penetration was 555 µm (725 µm using the nasal approach and 246.7 µm using the temporal approach) (P =.12). The globe was not ruptured in any eye. In a single right eye approached temporally using the right hand, the adventitial sheath of the central retinal artery was lacerated.

Conclusions  RON in human cadaver eyes results in lysis of the scleral canal at the ON head. Greater depth and improved safety of incision can be achieved by always approaching the incision from the nasal side of the ON using the dominant or nondominant hand.

Author Affiliations: Department of Ophthalmology and Visual Sciences, University of Wisconsin, Madison (Drs Altaweel, Freisberg, Pal, Gleiser, Dawson, and Albert); Retina Vitreous Consultants, Pittsburgh, Pennsylvania (Dr Freisberg); Dr Rajenda Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi (Dr Pal); Clinica Javier Prado, Lima, Peru (Dr Gleiser); Phillips Eye Institute, Minneapolis, Minnesota (Dr Ryan); and Bascom Palmer Eye Institute, Miami, Florida (Dr Dawson).

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