ويتركتومي همراه با برداشتن غشاي محدود كننده داخلي در انسداد حاد سياهرگ مركزي شبكيه در بيماران با ديد كم در زمان مراجعه

Vitrectomy with Internal Limiting Membrane Peeling in Acute Central Retinal Vein Occlusion Presenting with Low Vision

Purpose: To evaluate the visual and anatomical outcomes of pars plana vitrectomy and indocyanine green (ICG) assisted internal limiting membrane (ILM) peeling in fresh central retinal vein occlusion (CRVO) with primary low vision. Methods: In a prospective interventional case series, 15 eyes of 15 patients with fresh CRVO (less than 3 monthsʹ duration) and presenting best-corrected visual acuity (BCVA) less than 20/200, underwent standard 3-port pars plana vitrectorny and ICG assisted ILM peeling. BCVA and central macular thickness (CMT) by optical coherence tomography (OCT) were evaluated 2 weeks and 1, 2, 4 and 6 months postoperatively and when needed thereafter. Results: The patients included 8 male and 7 female subjects with mean age of 54.7±11.9 (range 29-75) years. Mean duration of symptoms at the time of surgery was 51.7±17.8 (range 26-85) days. CRVO was ischemic in 12 eyes (80%) and non-ischemic in 3 eyes (20%). Patients were followed for 9.5±4.8 (range 6-23) months. Mean BCVA (logMAR) was 1.86±0.37 at presentation which improved to 1.65±0.40 at 2 weeks (p~0.23), 1.68±O.39 at one month (P~0.095), 1.60±0.46 at2 months (P~0.069), 1.72±0.72 at4 months (P~0.423), 1.58±0.69 at 6 months (P~0.140) and 1.42±0.37 at last visit (p~0.006). Mean CMT was 605.5±279.2 11m preoperatively which was decreased to 527.4±274.3 urn at 2 weeks (P~0.371), 624.4±336.7 urn at one month (P~0.773), 546.4±344.9 11m at 2 months (P~ 0.491), 343.3±256.9 urn at 4 months (P~0.250), 369.3±207.5 urn at 6 months (P~0.078)and 368.9±199.0 urn at final visit (P~0.03). Condusion: Pars plana vitrectomy with ILM peeling in patients with fresh CRVO and low presenting visual acuity «20/200) may improve visual acuity and decrease in CMT in long-term follow-up, but does not seem to have any significant effect in comparison to the natural course of CRVO. Certain postoperative complications such as vitreous hemorrhage are relatively common requiring repeat vitreoretinal surgery_ Therefore, we do not recommend this procedure for such patients