Advances in Surgery for Retinal Arterial and Vein Occlusion
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In this review, the authors highlight the surgical management of patients with central retinal artery or vein occlusion (CRAO/CRVO). Patients with ischemic retinal vein occlusion may benefit from surgical intervention using vitrectomy with arterial–venous sheathotomy to reduce the burden of anti-VEGF injections; however, larger studies are needed. For patients with refractory cystoid macular edema, cystotomy with the removal of fibrinogen clots may have the potential to improve retinal vein occlusion outcomes, with a favorable success rate (78% in recent studies). Cannulation with tissue plasminogen activator may significantly improve visual outcomes in patients with CRAO, with studies showing an improvement in 30% of the patients with an embolic source and 100% of patients with a thrombus source.
- Surgical interventions for CRVO and CRAO may have the potential to improve anatomic and visual outcomes.
abstract
This abstract is available on the publisher's site.
Access this abstract nowPURPOSE OF REVIEW
To highlight the recent progression in surgical treatments for central retinal vein occlusion (CRVO) and central retinal artery occlusion (CRAO).
RECENT FINDINGS
Anti-VEGF treatment, accepted as a primary treatment for CRVO, is unable to effectively treat all types of the diseases. Regarding CRAO, there are not any accepted therapies available. There have however been recent innovations in surgery, such as utilizing robotics-assisted tools in cannulation procedures for central retinal artery occlusion, or micro-cystotomy for refractory macular edema resulting from ischemic CRVO.
SUMMARY
Refractory macular edema due to CRVO can be treated with aspiration of the fluid found inside the large cysts often seen in edema. The success rate of micro-cystotomy has been reported at 78% in eyes with refractory macular edema. Recent studies have shown that cannulation with tissue plasminogen activator (tPA) is effective for eyes with CRAO due to thrombus.Recent cannulation or micro-cystotomy procedures can be enhanced with the use of robotic tools which allow us to perform this difficult procedure more easily. Newly developed technology, and consequent developments in surgical procedures, will allow us to deal with unmet needs for retinal vessel occlusive diseases.
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Additional Info
Disclosure statements are available on the authors' profiles:
Retinal arterial and vein occlusion: is surgery ever indicated?
Curr Opin Ophthalmol 2024 May 01;35(3)210-216, K Kadonosono, M Inoue, Y YanagiFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
Kadonosono and co-authors wrote a concise review of current therapeutics for central retinal vein occlusion (CRVO) and central retinal artery occlusion (CRAO). Since ocular ischemia is considered an underlying cause, anti-VEGF therapy, a nonsurgical treatment, is a generally accepted strategy for treating CRVO and CRAO. However, in reality, a subset of ischemic retinal vein occlusion and all types of CRVO are not responsive to this treatment, as their multiple pathogenic factors are beyond the VEGF pathway. For instance, there are two types of blood clot formation in CRAO: embolism, which indicates surgical application, and thrombus, which requires mainly medical therapy. In order to target occlusive retinal vessels, several surgical approaches have been explored.
Notably, these types of surgeries, including micro-cystotomy and retinal vessel cannulation, are technically challenging. To fulfill the surgical need, this review, which included the authors' personal experience, introduced robotic-assisted microsurgery. Therefore, this review sheds new light on innovative surgical therapies for intractable subtypes of CRVO and CRAO.