Pars plana vitrectomy plus optic nerve neurotomy:
Is it a real benefit?

Jörg Chr. Schmidt, S. Hörle, S. Schulze (Marburg)

Background: Pathogenesis of central retinal vein (CRVO) is hypothesized to be compression of the intrascleral space. Current therapeutic options, including rheologic and laser coagulation, have a low success rate.
Patients and Methods: Pars plana vitrectomy plus removal of the internal limiting membrane, and a nasal scleral incision (neurotomy) were performed in 7 patients in whom hemorrhagic CRVO and visual acuity lower than 20/200 were diagnosed. Preand post-operative visual acuity, OCT, and fluorescein angiogram were performed.
Results: No hemorrhage was observed after neurotomy manoeuvre. In the follow-up time of 4 – 6 months the visual acuity improved to 20/200 – 20/100. In all cases the intraretinal hemorrhage clinically resorbed, although in OCT examination the retinal edema persisted. OCT examination disclosed an intact structure of the optic nerve fibre layer.
Conclusion: PPV plus neurotomy prevented occurrence of severe CRVO complications such as neovascularization. OCT examination is a useful tool for observing the fibre layer damage, and this complication did not occur in any patient. Further studies with a higher number of patients and additional injection of triamcinolone are warranted to observe the long-term anatomical and functional outcomes of this new surgical approach.


Back