Combined Radial Optic Neurotomy, Pars Plana Vitrectomy And Internal Limiting Membrane Peeling For Ischemic Central Retinal Vein Occlusion

Objective: To investigate the visual outcome of ischemic central retinal vein occlusion after radial optic neurotomy (RON), pars plana vitrectomy (PPV) and internal limiting membrane peeling on the macular.Method: This is a prospective, self-comparative, interventional series of cases. 13 patients (13 eyes) with ischemic central retinal vein occlusion were enrolled, All patients presented with visual acuity worse than 0.05, and the onset of symptom is less than 6 months. We performed pars plana vitrectomy, internal limiting membrane peeling on the macular, radial optic neurotomy and scattered endophotocoagulation on peripheral retina. The best corrected visual acuity (BCVA), fundus fluorescein angiography (FFA), fundus photography and optical coherence tomography (OCT) were performed before and at 1, 3, 6 months after the surgery to evaluate the efficacy of the surgery. The postoperative follow-up was 6 months.Result:1. Fundus photography showed reduction of hemorrhage and congestion of veins in all patients. Postoperative FFA demonstrated marked reduction of fluorescein leakage in the macular region compared to the preoperative FFA.2. The change on macular fovea thickness: The mean thickness at the foveal centre decreased from (645.8±356.1) preoperatively to (332.8±203.9)μm at 6 month visit. The postoperative macular fovea thickness has significant difference (P<0.05) compared with the preoperative fovea thickness at every observation point during the follow up.3. The change on visual acuity: The postoperative visual acuity ranged from hand move to 0.15.12 of 13 eyes got better visual acuity and 1 eye got worse visual acuity at the final follow-up. The postoperative visual acuity has significant difference (P<0.05) compared with the preoperative visual acuity at every observation point during the follow up.4. Complication: A transient vitreous hemorrhage was occurred in 2 patients during the follow-up.Conclusion:1. RON, PPV and internal limiting membrane peeling can be a safe and effective method to improve macular edema and intraretinal hemorrhage;2. Some patients may get a better visual acuity after the surgery.3. No serious complications were detected during the follow-up.