Adventitial sheathotomy for decompression of recent onset branch retinal vein occlusion

Interesting results have been reported on the use of pars plana vitrectomy with adventitial sheathotomy for the decompression of branch retinal vein o cclusions (BRVO). Recent onset BRVO responsible for a visual acuity of 20/4 0 or less have been estimated to be good candidates for this procedure. We report on the results of the prospective evaluation of three eyes (in three patients) with recent onset BRVO which underwent surgical decompression. T hree men, aged 40, 50, and 68 years presenting with BRVO for 4, 4, and 3 we eks respectively, underwent surgical decompression. Initial visual acuity w as 20/80, 20/80, and 20/200. After 11, 10, and 9 months follow-up, visual a cuity was 20/80, 20/200, and 20/200. In two eyes, an increase of the area o f retinal non-perfusion was treated with peripheral laser photocoagulation. No cataract, retinal tears or retinal detachment were observed. Conclusion : although feasible, sheathotomy did not lead to a significant visual impro vement in our patients. Dissection of the arteriovenous crossing could have induced vascular trauma. Furthermore, vitrectomy with posterior hyaloid de tachment alone could be of benefit in the treatment of branched retinal vei n occlusions. A prospective randomised trial is needed to assess the effect iveness and the safety of this procedure and to determine the best candidat es for surgery.