A Study of Surgical Approaches to Retinal Vascular Occlusions

Tang, W. M.; Han, Dennis P.

doi:10.1001/archopht.118.1.138

Cited by 68 publications

(37 citation statements)

References 15 publications

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“…These entities, the fact that a fair percentage of BRVO cases do not respond to laser photocoagulation [4], and the relatively limited functional gain of the BVO Study have led to the initiation of further search for new treatment modalities for macular edema in BRVO cases. Among these are the intravitreal injection of different concentrations of triamcinolone [5][6][7] or bevacizumab [8] and more invasive surgical approaches like cannulation of vein branches [9], arteriovenous branch sheathotomy [10], vitrectomy alone [11], and laser-induced formation of chorioretinal anastomoses [12]. Although results of several of these attempts seem to be promising, none has been subject of a randomized study report.…”

Section: Introductionmentioning

confidence: 99%

Combined intravitreal triamcinolone injection and laser photocoagulation in eyes with persistent macular edema after branch retinal vein occlusion

Riese¹,

Loukopoulos²,

Meier³

et al. 2008

Graefes Arch Clin Exp Ophthalmol

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Section: Introductionmentioning

confidence: 99%

Combined intravitreal triamcinolone injection and laser photocoagulation in eyes with persistent macular edema after branch retinal vein occlusion

Riese¹,

Loukopoulos²,

Meier³

et al. 2008

Graefes Arch Clin Exp Ophthalmol

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“…branch retinal vein occlusion [4], but which has been found to be generally traumatic when performed with the instrumentation presently available [5]. Additional opportunities for performance improvement exist in otorhinolaryngological, neurological, and microvascular surgery [6].…”

mentioning

confidence: 99%

Toward active tremor canceling in handheld microsurgical instruments

Riviere

Ang

Khosla

2003

IEEE Trans. Robot. Automat.

209

141

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Abstract-This paper describes research in active instruments for enhanced accuracy in microsurgery. The aim is to make accuracy enhancement as transparent to the surgeon as possible. Rather than using a robotic arm, we have taken the novel approach of developing a handheld instrument that senses its own movement, distinguishes between desired and undesired motion, and deflects its tip to perform active compensation of the undesired component. The research has therefore required work in quantification and modeling of instrument motion, filtering algorithms for tremor and other erroneous movements, and development of handheld electromechanical systems to perform active error compensation. The paper introduces the systems developed in this research and presents preliminary results.

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“…Surgical adhesion between the artery and vein at proximal arteriovenous crossings correlates with histopathologic findings of a common vascular wall observed in cases of branch retinal vein occlusion 16 and with studies of human cadaver eyes that underwent surgical manipulation of the retinal vasculature. 17 Conceivably, unless the conjoined vascular tissues are precisely divided, separation of the two vessels may result in a defect or tear in a vessel wall. No reports of complications relating to this aspect of surgical separation have yet been reported, despite many surgeries having been performed.…”

Section: Resultsmentioning

confidence: 99%

Sheathotomy For Treatment Of Branch Retinal Vein Occlusion

2006

J Liaquat Uni Med Health Sci

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INTRODUCTIONBranch retinal vein occlusion (BRVO) is a common retinal vascular disorder, second only to diabetic retinopathy as a cause of retinal vascular disturbance. 1,2The interruption of venous flow in these eyes almost always occurs at a retinal arteriovenous intersection, where a retinal artery crosses a retinal vein.3 BRVO is three times more common than CRVO. Men and women are affected equally. 4,5 The artery nearly always is anterior to the vein.6 Several medical and surgical interventions have been proposed to treat BRVO. The Branch retinal vein occlusion study demonstrated that Argon laser Photocoagulation may reduce visual loss from persistent macular edema and retinal neovascularization. But, photocoagulation is infective for restoring blood flow.7 Pars plana vitrectomy with surgical separation of the retinal artery from the underlying retinal vein at the site of pathological arteriovenous crossing has been advocated as a potential treatment for a branch vein occlusion and associated visual loss. PATIENTS AND METHODSThis study was performed on 20 consecutive patients with a branch vein occlusion and secondary macular dysfunction who underwent arteriovenous crossing dissection with attempt surgical separation of the artery and vein. Inclusion criteria were visual acuity of 20/60 or worse, less than 10 month duration. Exclusion criteria were presence of other vasculopathies, previous Grid laser photocoagulation and vitreous hemorrhage or retinal neovascularization. The pre-operative data from the patients included age, sex, eyes affected, duration of symptoms, refraction and best corrected visual acuity measurement. All 20 eyes underwent indirect ophthalmoscopy, slit lamp examination including biomicroscopy of the vitreous and retina. Fundus photography and FFA were also The surgical procedure consisted of a pars plana vitrectomy with separation of posterior hyaloid. A Bent tipped MVR blade was used to dissect the overlying retinal artery free from the retinal surface immediately proximal and distal to the pathologic arteriovenous crossing site. The artery was usually approached from both sides using a stroking motion of the blade tip. By connecting the incision from both sides of the artery, the artery was freed from the retinal surface. Post-operative follow up was performed from 1-2 months, 3-4 months and more than 6 months (final follow up). Subsequent FFA was assessed at varying intervals post-operatively, most of which had been performed from 3 to 5 months after surgery. For statistical analysis, the un-paired t-test was used to determine statistical significance with an alpha of 0.05. RESULTSTwenty patients underwent a pars plana viterctomy and sheathotomy consecutively. Eleven patients were males and nine females. The mean age was 69 years (Range = 39-84 years). The median duration of symptoms of vision loss was 16 weeks (Range= 6-156 weeks). Post-operative follow up was 01 to 15 months. In all cases, the artery was located anterior to the retinal vein at affected anterior venous crossing. In...

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A Study of Surgical Approaches to Retinal Vascular Occlusions

Cited by 68 publications

References 15 publications

Combined intravitreal triamcinolone injection and laser photocoagulation in eyes with persistent macular edema after branch retinal vein occlusion

Combined intravitreal triamcinolone injection and laser photocoagulation in eyes with persistent macular edema after branch retinal vein occlusion

Toward active tremor canceling in handheld microsurgical instruments

Sheathotomy For Treatment Of Branch Retinal Vein Occlusion

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