Surgical decompression of branch retinal vein occlusion via arteriovenous crossing sheathotomy - A prospective review of 15 cases

Background: Branch retinal vein occlusion (BRVO), the second most common va scular disorder of the retina, typically occurs at arteriovenous (A/V) cros sings where the arteriole and venule share a common adventitial sheath. Mec hanical narrowing of the Venous lumen at these intersections is thought to play a pathoetiologic role in BRVO. Methods: We performed surgical decompression of BRVO via A/V crossing sheat hotomy in 15 patients with decreased visual acuity due to macular hemorrhag e, edema, and ischemia. Reperfusion of the retina was achieved by surgicall y separating the overlying retinal arteriole from the venule via vitrectomy and adventitial sheathotomy techniques. Results: Intraoperative decompression of the A/V crossing was achieved in a ll 15 patients. All patients showed clinical improvement as determined by f undus examination, photography, and fluorescein angiography. Postoperative visual acuities were equal or improved in 80% of patients. Ten of the 15 su bjects (67%) had improved visual acuity with an average gain of four lines of vision. Conclusion: Surgical decompression of BRVO via A/V crossing sheathotomy is a technically feasible procedure that can result in rapid reperfusion of th e retina. Resolution of macular hemorrhage, edema, and ischemia may improve visual prognosis in patients with this common retinal vascular disorder.