18. Long-Term Outcomes of Vitrectomy and Posterior
Hyaloidal Separation for Retinal Vein Occlusions
Tarek S. Hassan (Royal Oak)
Purpose: To assess the long-term visual and anatomic outcomes of eyes that underwent
vitrectomy and posterior hyaloidal separation for macular edema secondary to retinal vein
occlusion.
Methods: Medical records of consecutive patients that underwent vitrectomy and posterior
hyaloidal separation for macular edema secondary to branch retinal vein occlusion (BRVO),
central retinal vein occlusion (CRVO), or hemi-retinal vein occlusion (HRVO) were retrospectively
reviewed. Only patients with > 12 months follow-up were included. Studied variables
included Snellen visual acuity (VA), status of macular edema by clinical exam, fluorescein
angiographic (FA) findings, and optical coherence tomography (OCT), complications, and additional
postoperative interventions.
Results: 25 eyes (7 BRVO, 16 CRVO, 2 HRVO) from 24 patients met inclusion criteria. The mean age was 70 years, duration
of symptoms was 11 months, and follow-up was 27 months (range, 12 to 42). Nine eyes (36 %) received laser photocoagulation
and 5 eyes (20 %) underwent intravitreal steroid injection before vitrectomy. The mean preoperative VA was
20/300, best postoperative VA was 20/150 (p=0.012), and VA at the most recent follow-up exam was 20/200 (p=0.34). At
the last follow-up visit, 18 eyes (72 %) experienced stable or improved vision. The mean duration of a non-edematous clinical
exam was 18 months. Pre- and post-operative FAs were available for 22 eyes, and 20 eyes (91 %) showed improved or
resolved macular edema postoperatively. Mean macular thickness by OCT decreased from 487 to 281 microns at the most
recent follow-up exam (n=18, p<0.0001). Macular ischemia was noted in 41 % of preoperative FAs but increased to 64 %
of postoperative FAs. During the follow-up period, 8 eyes (32 %) underwent cataract surgery, 7 eyes (28 %) received intravitreal
bevacizumab, 6 eyes (24 %) were injected with intravitreal triamcinolone, and 2 eyes (8 %) underwent retinal detachment
repair.
Conclusions: Vitrectomy with posterior hyaloidal separation can lead to long-term anatomic improvement of macular edema
secondary to retinal vein occlusion. At some point during follow-up, there was a strong trend for VA improvement, but VA
remained poor in most eyes at the latest follow-up visit due to the development of increased macular ischemia.