Controversies in the surgical treatment of RVO ‐ Associated macular edema

Abstract

AbstractMacular edema is the main cause of decreased visual acuity in retinal vein occlusions (RVOs). Most approaches to the management of RVOs, such as grid macular laser photocoagulation and intraocular injections of drugs, are addressed to reduce the permeability of the macular vascular net and to increase the vitreoretinal fluid exchange of oxygen and protecting factors. However, we need to solve the primary mechanism of the disease: the vein occlusion. In order to reperfuse the thrombosed vein, Radial Optic Neurotomy (RON) is a surgical procedure aimed at solving the “compartment syndrome” that may exist in eyes with CRVO or hemicentral RVO. Sheathotomy specifically releases the compressive factor at the arteriovenous crossings by sectioning the adventicial seath. Recombinant tissue plasminogen activator (r‐tPA) has been administered by several routes, including systemic, intravitreal and by endovascular cannulation of retinal vessels. PPV with peeling of the internal limiting membrane has also been suggested. Surgery remains a good treatment option for patients with very recent and edematous occlusion with poor visual acuity, as reperfusion of the vein is the best approach to treat the macular edema and avoid ischemic complications.