Concept Radial Optic Neurotomy

10/22/2012
Surgical Management
Radial Optic Neurotomy
– Surgical procedure to
relieve compression at
scleral outlet
– Relax confines of CRV
– Variable reports of success
Radial Optic Neurotomy Concept
Hypothesis Compartment Sx
Opremcak EM et al,
2001 and 2003
Radial Optic Neurotomy
3-port pars plana vitrectomy
20g vs 25g
Posterior hyaloid separation
Radial nasal incision
20g vs. 25g MVR blade
Hemostasis
+/+/- intravitreal triamcinolone
acetate (4mg)
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10/22/2012
Radial Optic Neurotomy - Results
Study
PreVA
PostVA F/U
Compls
Opremcak, 2001 11
Eyes
Dur
20/400
82% =
or ⇑
None
Other
73% ⇑ of 5
lines
Le Rouic, 2003
10
20/200
20/100
4.5mo
None
Shunt=3
Garcia, 2003
14
2.1wk
20/250
20/80
9.6mo
Subret
heme=3
Weizer, 2003
5
5.4mo 4/200
20/400
4.5mo
Choroidvit
NV=1
Nomoto, 2004
15
4mo
20/200
20/100
6mo
Subret
heme=2
Spaide, 2004
6
2.3mo 20/400
20/400
3mo
None
Shunt=6
57% ⇑ 1 or
more
80% ⇑
40% ⇑ to
20/80
Shunt=7
⇓ ret circ
time=8
Shunt=5
⇓ macular
thickness
1021⇒733
Radial Optic Neurotomy - Results
Study
Eyes Dur
Opremcak,
2003
117
APD F/U
VA results
7mo 57% 9mo Equal/better=94%
Avg gain +2.5
lines
25% +4 lines
41% +3 lines
Compls
SubR heme
6%
VH 4%
ANV 6%
Shunt 8%
Radial Optic Neurotomy – Retina Institute of
California Experience
Purpose: Review our initial experience with RON for CRVO
Purpose:
Methods:: Retrospective, chart review, OR records (1/1/01)
Methods
Intervention:: PPV (20 or 25g), RON, +/Intervention
+/- IV TA (4mg)
Measures:: Visual acuity, macular edema, FA perfusion status
Measures
Results
–
–
–
–
8 eyes / 8 patients ( 1 male, 7 female)
Avg age - 73.2 years
Mean duration of symptoms - 3.9 months (3 weeksweeks-1 year)
Pre--op perfusion status - perfused (3), nonperfused (1),
Pre
indeterminate (4)
– Mean followfollow-up - 7.6 months (1(1-24 months)
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Radial Optic Neurotomy - Retina Institute of
California Experience
Mean preoperative VA - 5/200
Mean postoperative VA - 20/400
4 patients improved VA (50%)
4 patients maintained VA (50%)
One patient improved from CF to 20/50
Macular edema - resolved in 2 eyes, decreased in 6 eyes
Mean OCT foveal thickness 595 ⇒ 394 microns (3 eyes)
Bottom Line: Reasonable option for hemorrhagic CRVO
with 20/200 VA or worse
CRVO: Treatment Paradigms
1) NonNon-ischemic CRVO:
a) NonNon-Hemorrhagic - Observe
b) Hemorrhagic - RON
- Avastin
2) Ischemic CRVO: PRP
Avastin
3