Management of branch retinal vein occlusion with vitrectomy and arteriovenous adventitial sheathotomy, the possible role of surgical posterior vitreous detachment.

Background: To analyze the results of vitrectomy and adventitial sheathotomy in the management of branch retinal vein occlusion (BRVO). This is a nonrandomized interventional case series.

Methods: Patients with BRVO with progressive decrease in visual acuity underwent surgery and were prospectively evaluated in two centers. Surgical procedure included a 3-port pars plana vitrectomy, removal of the internal limiting membrane and arteriovenous crossing sheathotomy. Clinical evaluation consisted of best-corrected visual acuity, fluorescein angiography and optical coherence tomography.

Results: Thirteen eyes were analyzed consecutively. An improvement in visual acuity of two ETDRS lines or more was observed in nine eyes (69%). The mean gain was 1.9 ETDRS lines. The absence of previous posterior vitreous detachment (PVD), poor initial visual acuity and the presence of retinal ischemia were correlated to the improvement in vision (P=0.014, P=0.002 and P=0.052, respectively). Eyes with initial PVD had a mean loss postoperatively of -5.7 lines, but eyes without PVD experienced a gain of 4.2 lines (P<0.001). Macular edema decreased significantly (preoperative thickness: 714 micro m, postoperative thickness: 353 micro m, P=0.04), whereas the aspect of the vein at the crossing and the non-perfused area remained unchanged.

Conclusion: Vitrectomy with sheathotomy seems to be of benefit in the management of BRVO, particularly in eyes with no previous PVD, and the main postoperative feature was the decrease in macular edema. The surgical detachment of posterior hyaloid could be as important (or more) as the sheathotomy itself. Further studies are needed to define the most efficient surgical management of BRVO.