[Treatment of retinal venous occlusion with hemodilution and laser coagulation. Prevention of secondary glaucoma].

BACKGROUND

Neovascular glaucoma is similarly as other ocular neovascularizations, a complication of retinal venous occlusions. The objective of the present work was to assess whether it is possible to prevent this complication by isovolaemic haemodilution and laser coagulation of the retina.

METHODS AND RESULTS

Between 1991 and 1996 we used in 10 patients with occlusion of the central retinal vein and in 25 patients with occlusion of the branch of the central retinal vein repeated haemodilution with reduction of the haematocrit to 0.36. In case of soft retinal exudates the retina was treated by laser coagulation. The whole group comprised 28 men and 7 women. The patients' age was 42 to 76 years, 14% of the patients were under 50 years. The mean follow-up period was 29.5 months. During the investigation period so far none of the patients developed neovascular glaucoma. After treatment venous collaterals developed in the retina in 48.5%, in the disc of the optic nerve in 16% of the patients. Improved visual acuity was recorded in 90% of the patients after occlusion of the trunk and in 44% patients after occlusion of the branch of the central retinal vein.

CONCLUSIONS

Adjustment of rheological conditions by haemodilution improved for three months the haemodynamic conditions in the affected retina, promote recanalization of the occluded vessels and the development of a collateral circulation and prevented neovascularization. Based on their experience the authors assume that haemodilution combined with laser coagulation has a positive impact on the visual prognosis, but in particular on prevention of neovascular glaucoma, which so far did not develop in the thus treated patients.