Laser chorioretinal venous anastomosis for nonischemic central retinal vein occlusion.

OBJECTIVE: This study aimed to test the efficacy and safety of laser chorioretinal anastomosis for central retinal vein occlusion (CRVO). DESIGN: The study design was a consecutive case series. PARTICIPANTS: Eight eyes of eight patients were treated. INTERVENTION: The argon laser was used in the method of McAllister and Constable to attempt to form an anastomosis. The patients were observed for 1 to 19 months (median, 11 months). MAIN OUTCOME MEASURES: Visual acuity, anastomosis success, and complications were measured. RESULTS: Twenty attempts to create anastomoses were made with 2 successful anastomoses but not of a therapeutic type. Three patients developed rubeosis, retinal neovascularization at the laser site, and vitreous hemorrhage. Traction retinal detachment occurred twice and neovascular glaucoma occurred once. Secondary panretinal photocoagulation, pars plana vitrectomy, and glaucoma seton were required in three patients, one patient, and one patient, respectively. Visual acuity improved in two patients independent of failed attempts at anastomosis creation and did not improve or worsened in six patients, including the two patients with the successfully created anastomoses. CONCLUSION: Laser chorioretinal anastomosis for nonischemic CRVO has greater risks and less success than the initial report suggested. Further refinement of the technique is needed before it is adopted extensively. Even when successful, macular pigment epithelial scarring can limit vision, implying a relatively short time window for its effective application in the face of severe macular edema. Successful laser chorioretinal anastomosis does not preclude development of anterior segment neovascularization.

Duke Scholars

Author David Judson Browning Ophthalmology

Author Andrew N. Antoszyk Ophthalmology