Barak Adiel, Kesler Anat, Gold Daniel, Loewenstein Anat
Department of Ophthalmology, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Israel.
Retina. 2006 May-Jun;26(5):549-54. doi: 10.1097/00006982-200605000-00009.
Surgical decompression of the vein in central retinal vein occlusion (CRVO) by radial optic neurotomy (RON) was recently proposed as being surgically feasible, safe, and beneficial. The effect of RON on the visual field has not been systematically reported, although possible visual field defects are expected due to iatrogenic cutting of the optic nerve fibers. The authors report the results of visual field testing in patients who underwent RON at the Tel Aviv Medical Center.
Twelve consecutive patients (8 men, mean age of all patients 68 years) with nonperfused or indeterminate CRVO whose initial visual acuity (VA) was < or =20/400 underwent RON. Nine of these patients were able to perform visual field tests at 6 months post-RON and their visual field results are presented.
: VA improved by > or =3 lines in 5 patients (42%). Three (25%) patients had a final VA of > or =20/200 and another had a final VA > or =20/50. Fundus and VA improvement were relatively slow. Two patients had clearing of the intraretinal blood, resolution of the venous dilation, and improved VA at the 2-month follow-up visit. Temporal visual field defects consisting of temporal ones that could be correlated to the site of the RON incision were detected in five out of the nine patients who were able to perform visual field tests. No temporal visual field defects were found in the remaining four patients, and three other patients were unable to perform visual field tests due to inability to identify the largest target size.
VA improvement in 5 of 12 patients with ischemic or indeterminate CRVO following RON may be better than the natural history of CRVO. The risk of visual field defects may, however, be heightened by possibly cutting off blood supply to the optic nerve head and possible damage to nerve fibers in the optic nerve head, both inherent to the surgical procedure and both likely to produce visual loss.
最近有人提出，通过放射状视神经切开术（RON）对视网膜中央静脉阻塞（CRVO）患者的静脉进行手术减压在手术上是可行、安全且有益的。尽管由于医源性切断视神经纤维可能会导致视野缺损，但RON对视野的影响尚未有系统报道。作者报告了在特拉维夫医疗中心接受RON治疗的患者的视野测试结果。
连续12例（8例男性，所有患者平均年龄68岁）非灌注性或不确定型CRVO患者，其初始视力（VA）≤20/400，接受了RON治疗。其中9例患者在RON术后6个月能够进行视野测试，并展示了他们的视野结果。
5例患者（42%）的VA提高了≥3行。3例患者（25%）最终VA≥20/200，另1例患者最终VA≥20/50。眼底和VA改善相对缓慢。2例患者在2个月的随访中视网膜内出血清除、静脉扩张消退且VA改善。在能够进行视野测试的9例患者中，有5例检测到与RON切口部位相关的颞侧视野缺损。其余4例患者未发现颞侧视野缺损，另外3例患者因无法识别最大目标尺寸而无法进行视野测试。
12例缺血性或不确定型CRVO患者在RON术后，5例患者的VA改善可能优于CRVO的自然病程。然而，手术过程中固有的切断视神经乳头血供的可能性以及对视神经乳头神经纤维的可能损伤，都可能增加视野缺损的风险，两者都可能导致视力丧失。
