Trans-Luminal Nd:yag Laser Embolysis for Branch Retinal Artery Occlusion

Mason, John O.; Nixon, Peter A.; Albert, Michael A.

doi:10.1097/iae.0b013e3180546c4d

Cited by 24 publications

(21 citation statements)

References 5 publications

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“…For example, it has been claimed that YAG laser embolysis/embolectomy in BRAO resulted in visual acuity improvement 14,15. As discussed elsewhere16, there are flaws in the study by Opremcak and colleagues15 which invalidate their claims; moreover, the procedure resulted in complications in 47%, including vitreous/ subhyaloid hemorrhages.…”

Section: Discussionmentioning

confidence: 99%

Branch Retinal Artery Occlusion

2009

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Objective-To investigate systematically the natural history of visual outcome in branch retinal artery occlusion (BRAO). Design-Cohort study.Participants-199 consecutive untreated patients (212 eyes) with BRAO, first seen in our clinic from 1973 to 2000.Methods-At first visit, all patients had a detailed ophthalmic and medical history, and comprehensive ophthalmic evaluation. Visual evaluation was done by recording visual acuity, using the Snellen visual acuity chart, and visual fields with a Goldmann perimeter. The same ophthalmic evaluation was performed at each follow-up visit. Main Outcome Measures-Visual acuity and visual fields.Results-BRAO was classified into permanent (133 eyes) and transient (18 eyes) BRAO and cilioretinal artery occlusion (CLRAO -61 eyes). In eyes with permanent BRAO, of the 61 eyes seen within 7 days of onset, initial visual acuity was 20/40 or better in 74%, central scotoma in 20%, central inferior altitudinal defect in 13%, and inferior nasal and superior sector defects in 29% and 24% respectively. Of those with follow-up, in the eyes with visual acuity worse than 20/40, it improved in 79% (11 of 14), abnormal central visual field defect improved in 47%, and abnormal peripheral visual field defect improved in 52%. Of the 18 eyes with transient BRAO, initially 17 (94%) had visual acuity of 20/40 or better and one (6%) worse that 20/40, which improved to 20/30 on follow-up. Of the 11 eyes with nonarteritic CLRAO alone, visual acuity was worse than 20/40 in 3 eyes -that improved to 20/40 or better in all during follow-up. In CLRAO on follow-up of 9 eyes, the central field improved in 4. When CLRAO was associated with retinal vein occlusion (38 eyes) or giant cell arteritis (12 eyes), visual findings were influenced by the associated diseases. Correspondence to: Dr. S.S. Hayreh, Department of Ophthalmology and Visual Sciences, University Hospitals & Clinics, 200 Hawkins Drive, Iowa City, Iowa 52242-1091, Telephone No. 319-356-2947.edu. Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.This article contains online-only material. The following should appear online-only: Tables 2,4,5 and 7."The authors have no conflict of interest. NIH Public Access Author ManuscriptOphthalmology. Author manuscript; available in PMC 2010 June 1. Conclusion-These findings show that visual acuity of 20/40 or better is seen initially in 74% of permanent BRAO, 94% of transient BRAO and 73% of nonarteritic CLRAO alone; and finally on follow-up, in 89%, 100% and 100% respectively. The effectiveness of various treatment modalities for visual outcome has to be judged ...

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Section: Discussionmentioning

confidence: 99%

Branch Retinal Artery Occlusion

2009

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“…For example, it has been claimed that YAG laser embolysis/embolectomy in BRAO resulted in VA improvement (Mason et al, 2007; Opremcak et al, 2008). As discussed elsewhere (Hayreh, 2008), there were flaws in the study by Opremcak et al (2008) which invalidate their claims; moreover, the procedure resulted in complications in 47%, including vitreous/subhyaloid hemorrhages.…”

Section: Natural History Of Visual Outcome In Branch Retinal Artementioning

confidence: 99%

Ocular vascular occlusive disorders: Natural history of visual outcome

Hayreh

2014

Progress in Retinal and Eye Research

262

197

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Ocular vascular occlusive disorders collectively constitute the most common cause of visual disability. Before a disease can be managed, it is essential to understand its natural history, so as to be able to assess the likely effectiveness of any intervention. I investigated natural history of visual outcome in prospective studies of 386 eyes with non-arteritic anterior ischemic optic neuropathy (NA-AION), 16 eyes with non-arteritic posterior ischemic optic neuropathy, 697 eyes with central retinal vein occlusion (CRVO), 67 eyes with hemi-CRVO (HCRVO), 216 eyes with branch retinal vein occlusion (BRVO), 260 eyes with central retinal artery occlusion (CRAO), 151 eyes with branch retinal artery occlusion (BRAO) and 61 eyes with cilioretinal artery occlusion (CLRAO). My studies have shown that every one of these disorders consists of multiple distinct clinical sub-categories with different visual findings. When an ocular vascular occlusive disorder is caused by giant cell arteritis, which is an ophthalmic emergency, it would be unethical to do a natural history study of visual outcome in them, because in this case early diagnosis and immediate, intensive high-dose steroid therapy is essential to prevent any further visual loss, not only in the involved eye but also in the fellow, normal eye. In NA-AION in eyes seen ≤2 weeks after the onset, visual acuity (VA) improved in 41% of those with VA 20/70 or worse, and visual field (VF) improved in 26% of those with moderate to severe VF defect. In non-ischemic CRVO eyes with VA 20/70 or worse, VA improved in 47% and in ischemic CRVO in 23%; moderate to severe VF defect improved in 79% in non-ischemic CRVO and in 27% in ischemic CRVO. In HCRVO, overall findings demonstrated that initial VA and VF defect and the final visual outcome were different in non-ischemic from ischemic HCRVO – much better in the former than the latter. In major BRVO, in eyes with initial VA of 20/70 or worse, VA improved in 69%, and moderate to severe VF defect improved in 52%. In macular BRVO with 20/70 or worse initial VA, it improved in 53%, and initial minimal-mild VF defect was stable or improved in 85%. In various types of CRAO there are significant differences in both initial and final VA and VF defects. In CRAO eyes seen within 7 days of onset and initial VA of counting fingers or worse, VA improved in 82% with transient non-arteritic CRAO, 67% with non-arteritic CRAO with cilioretinal artery sparing, 22% with non-arteritic CRAO. Central VF improved in 39% of transient non-arteritic CRAO, 25% of non-arteritic CRAO with cilioretinal artery sparing and 21% of non-arteritic CRAO. Peripheral VF improved in non-arteritic CRAO in 39% and in transient non-arteritic CRAO in 39%. In transient CRAO, finally peripheral VFs were normal in 93%. In non-arteritic CRAO eyes initially 22% had normal peripheral VF and in the rest it improved in 39%. Final VA of 20/40 or better was seen in 89% of permanent BRAO, and in 100% of transient BRAO and non-arteritic CLRAO. In permanent BRAO eyes, among those seen wit...

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“…However, complications such as vitreous hemorrhage and subretinal hemorrhage were observed 3,4. In the present cases, laser treatment resulted in dramatic improvement in BCVA and restoration of retinal blood flow despite a small amount of vitreous hemorrhage.…”

Section: Discussionmentioning

confidence: 45%

“…Recent studies indicated that Nd:YAG laser embolysis (NYE) treatment resulted in successful restoration of retinal blood flow and improved best-corrected visual acuity (BCVA) 3,4. The present report describes outcomes following the treatment of two cases of BRAO with NYE.…”

mentioning

confidence: 87%

Treatment of Branch Retinal Artery Occlusion With Transluminal Nd:YAG Laser Embolysis

Lim

Lee

Chung

et al. 2009

Korean J Ophthalmol

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The purpose of this paper was to report a successful treatment of transluminal Nd:YAG laser embolysis (NYE) for branch retinal artery occlusion (BRAO) with visible emboli. Two patients with acute, severe vision loss secondary to a branch retinal artery occlusion with visible emboli in one eye underwent NYE. A complete ocular examination was performed which included biomicroscopy of the posterior pole of the retina, intraocular pressure measurement, fundus color photographs, and fluorescein angiography (FA). After the NYE, the two patients showed dramatic improvements in best-corrected visual acuity, as well as, immediate and dramatic restorations in flow past the obstructed arteriole in FA. NYE is a treatment modality to be considered in patients with BRAO who present acutely with severe vision loss and a visible embolus.

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Trans-Luminal Nd:yag Laser Embolysis for Branch Retinal Artery Occlusion

Abstract: TYE is a treatment modality to be considered in patients with BRAO who present acutely with severe vision loss and a visible embolus. The risks of TYE must be weighed against the possibility of severe and permanent loss of vision secondary to BRAO.

Cited by 24 publications

References 5 publications

Branch Retinal Artery Occlusion

Branch Retinal Artery Occlusion

Ocular vascular occlusive disorders: Natural history of visual outcome

Treatment of Branch Retinal Artery Occlusion With Transluminal Nd:YAG Laser Embolysis

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