Pars Plana Vitrectomy Combined With Internal Limiting Membrane Peeling For Ischemic Central Retinal Vein Occlusion: A 5 Cases Report

Objective: Central retinal vein occlusion(CRVO) which is one of the mo- st common clinical disorders has 2 different types:the ischemic and the nonisc- hemic.The former can lead to a worse prognosis due to the macular edema and neovascular glaucoma(NVG) secondary to CRVO.Pars plana vitrectomy(PPV) combined(or not) with internal limiting membrane peeling(ILM peeling) is a kind of newly developing operation technique for CRVO.Panretinal photocoagulation(PRP) and intravitreal Triamcinolone Acetonide(IVTA) have been used as the therapy to NVG and macular edema for many years.So we designed the operation as PPV combined with PRP,ILM peeling and IVTA 4mg for ischemic CRVO.The purpose of the study is to observing the clinical effect of the technique,discussing the complications and probable mechanism in order to supply the reference.Methods: 6 eys of 6 patients that were diagnosed as ischemic CRVO in our hospital(the department of Ophthalmology of the second hospital of Hebei Medical University) met the selection.All eyes received PPV combined with PRP,ILM peeling and IVTA 4mg.We observed the best correct visual acurity(BCVA) 1d,2d,3d,1week,1month after the therapy,the intraocular press- ure 3d,1week,1month after the therapy,the central macular thickness(CMT) and fundus fluorescein angiography(FFA) 1month afer the therapy and made the comparison before treatment.Results:1 6 eyes of 6 patients met the study,1 patient lost the follow-up.5 eyes of 5 patient met the final stuty.At the end of the study,the BCVA of 4 eyes improved,1 eye had no different.2 The intraocular pressures of all the eyes before therapy were in the range of 9~21mmHg.At the end of follow-up,the intraocular pressures of 2 eyes were higher than that before treatment,3 eyes decreased,all the eyes were bellow 21mmHg.3 All the eyes had no NVG before therapy.At the end of the study,no complications were observed in all patients.4 At the end of the follow-up,all patients had marked improvement in hemorrage and venous engorgement.4 patient had improvement of macular edema,1 patient had the relapse.5 1 month after the operation,the CMT of 4 eyes decreased,the best of them had the decreasing amplitude of 630μm.1 eye increased.6 The FFA showed 4 patients had improvement in disk edema, retinal hemorrage and venous engorgement at 1 month after treatment.1 patient had no improvement of macular edema.7 There were no complications found postoperative.Conclusions:1 The therapeutic effect of PRP+PPV+ILM peeling+IVTA4mg is defi- nite.2 The effect of PRP+PPV+ILM peeling+IVTA4mg for improving hemorr- age and macular edema is clear.3 A large sample and long term follow-up is needed.