Radial Neurotomy of the Optic Nerve Disc in Central Retinal Vein Occlusion (Case Reports)

Overview

The basic aim of this paper is to introduce the case reports of two patients with the ischaemic form of the central vein occlusion with very low preoperative best-corrected visual acuity (BCVA) and with very unfavorable prognosis, treated by means of radial neurotomy of the optic nerve disc (RNO) during the pars plana vitrectomy (PPV).

Radial neurotomy of the optic nerve disc (RNO) was performed in two patients with ischaemic form of the central vein occlusion with very unfavora prognosis during the pars plana vitrectomy in the nasal part of the rim of the optic nerve disc between nasal retinal vascular arcades with specially designed knife (Spaide CRVO knife), as described by Opremcak. The surgery was supplemented with the peeling of the epiretinal membranes and inner limiting membrane, using the Membrane blue. Both eyes were due to uncomplicated course of the operations left without the inner tamponade. RNO represents surgical treating method reserved for ischaemic CRVO with unfavorable prognosis. The key role in the pathological physiology of the RNO plays not only the breaking of the compartment system, but also acceleration of the collateral chorioretinal circulation, as we observed in both of our patients.

The BCVA in the first patient improved from 1/50 (0.02 or 3/150) to 3/50 (0.06 or 20/333), and in the second one from 1/50 (0.02 or 3/150) to 5/30 (0,17 or 20/120). In both patients, the retinal hemorrhages and the edema markedly resorbed, the dilatation of the venous vessels disappeared as well as the edema of the optic nerve disc. The region of the scar after the neurotomy remained quiet without signs of retinal or choroidal neovascularizations.

The authors demonstrate on their own case reports the efficacy of the RNO in two patients with prognosticaly unfavorable ischaemic form of the BRVO. The RNO seems to be a promising method suitable for the treatment in prognosticaly unfavorable ischaemic forms of the BRVO.

Key words:
central retinal venous occlusion, radial neurotomy of the optic nerve disc.