Radial Optic Neurotomy for Central Vein Occlusion-
First Experiences

Susanne Binder (Vienna)

Background: Although the etiology of central vein occlusion is not completely clear and probably multifactorial, the only common finding in histopathology is an obstruction by a thrombus of the central vein in the area of the lamina cribrosa. A relaxing Radial Optic Neurotomy was recommended as a new surgical procedure by Opremcak in 2001. We perform this surgery since December 2001 in our clinic. The surgical technique as well as clinical results , Angiographic results and Optical Coherence tomographic results as well as multifocal ERG`s of a pilot study will be presented.
Material and Methods: Patients with non perfused central vein occlusions were included. The surgery consisted of a standard p.p. vitrectomy, removal of the Membran Limitans Interna and a radial cut of the optic nerve through the lamina cribrosa. Pre- and postoperatively beside clinical examinations and visual acuity tests, Fluorescein angiographies, Optical Coherence Tomographies and multifocal ERG`s were performed after 1 month and in 3 months intervals thereafter.
Results: 12 patients were included in this pilot study between Dezember 2001 and March 2003. The medium age was 77.7 years , five were woman. Surgery was uneventful in all eyes. Postoperatively after a minimal observation of 3 months we found visual improvement of one to 3 lines in 8 of 11(73%), a reduction of the CMÖ in 8 of 9 eyes (83 %), improved perfusion on fluoresceinangiography in 7/11(64%) but unchanged potentials with mERG`s. In one eye the retinal ischemia progressed and a rubeosis iridis with secondary glaucoma developed 1 months after surgery.
Conclusions: Radial Optic Neurotomy is a technical feasible procedure which might allow reperfusion in some cases of CVO. Additional peeling of the ILM could be helpful in the reduction of the CMÖ and improvement of visual acuity. Comparative studies with long term results are needed.


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