García-Arumí Jose, Martinez-Castillo Vicente, Boixadera Ana, Blasco Hugo, Corcostegui Borja
Hospital Vall d'Hebrón, Universidad Autónoma de Barcelona, Spain.
Retina. 2004 Aug;24(4):530-40. doi: 10.1097/00006982-200408000-00005.
The common adventitial sheath that surrounds the retinal venule and arteriole at the crossing site plays a crucial role in branch retinal vein occlusion (BRVO). The purpose of this study was to report the surgical recanalization of the occluded vein using a bimanual technique and recombinant tissue plasminogen activator (tPA) and its effect on final visual acuity.
Arteriovenous sheathotomy was performed, using a bimanual technique, followed by fluid-air exchange and injection of 25 mg of recombinant tPA over the area of the occluded vein.
Intraoperative sectioning of the common arteriovenous sheath was achieved in all 40 patients. Thrombus release was observed in 11 cases (27.5%) and was correlated with early surgery (P < 0.001) and better final visual recovery (P < 0.06). Optical coherence tomography showed macular thickness that decreased by greater than 40% in 31 patients (77.5%) compared with preoperatively, and correlated to postoperative visual acuity (P < 0.001). The mean visual acuity increased from 20/100 to 20/40, with 70% of patients gaining three or more lines of visual acuity (Pearson 0.378, P = 0.016).
Surgical venous decompression and injection of recombinant tPA may effectively manage macular edema secondary to BRVO, thus improving anatomic and visual outcome. Early surgical intervention may obtain maximum final visual recovery.
视网膜动静脉交叉处周围的共同外膜鞘在视网膜分支静脉阻塞（BRVO）中起关键作用。本研究的目的是报告使用双手操作技术和重组组织型纤溶酶原激活剂（tPA）对阻塞静脉进行手术再通及其对最终视力的影响。
采用双手操作技术进行动静脉鞘膜切开术，随后进行液气交换，并在阻塞静脉区域注射25mg重组tPA。
40例患者均成功进行了术中动静脉共同鞘膜切开。11例（27.5%）观察到血栓溶解，这与早期手术（P<0.001）和更好的最终视力恢复相关（P<0.06）。光学相干断层扫描显示，31例患者（77.5%）黄斑厚度较术前下降超过40%，且与术后视力相关（P<0.001）。平均视力从20/100提高到20/40，70%的患者视力提高了3行或更多（Pearson相关系数0.378，P=0.016）。
手术性静脉减压和注射重组tPA可有效治疗BRVO继发的黄斑水肿，从而改善解剖结构和视力结果。早期手术干预可能获得最大程度的最终视力恢复。
