Home About us Editorial board Ahead of print Current issue Search Archives Submit article Instructions Subscribe Contacts Login 
  • Users Online: 788
  • Home
  • Print this page
  • Email this page

   Table of Contents      
LETTER TO EDITOR
Year : 2005  |  Volume : 53  |  Issue : 3  |  Page : 211-212

Author's reply


Retina Foundation, Ahmedabad, India

Correspondence Address:
Kamal Nagpal
Retina Foundation, Near Shahibag Underbridge, Rajbhavan Road, Ahmedabad - 380 004
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


Rights and PermissionsRights and Permissions

How to cite this article:
Nagpal K, Nagpal M. Author's reply. Indian J Ophthalmol 2005;53:211-2

How to cite this URL:
Nagpal K, Nagpal M. Author's reply. Indian J Ophthalmol [serial online] 2005 [cited 2020 Jun 4];53:211-2. Available from: http://www.ijo.in/text.asp?2005/53/3/211/16690

Dear Editor,

We thank Dr Singh and colleagues for the interest in our article and the important aspects raised by them. We would like to present our viewpoint regarding the same.

Development of chorio-retinal anastomosis (CRA) subsequent to Radial optic neurotomy (RON) is believed to assist retinal venous outflow.[1],[2] It has been hypothesised that RON may cause CRA earlier than the natural course of central retinal vein occlusion (CRVO), leading to improvement in retinal circulation before irreversible severe damage to retina.[3] Furthermore, it has been suggested that CRA may develop more frequently in cases with non-ischaemic than in ischaemic CRVO. [3]

We could not document the formation of such chorioretinal shunt vessels in the post-operative angiograms, in cases which were included in this series. However, in subsequent cases of CRVO, which underwent RON at our centre, we have been able to show CRA formation on post-operative angiography [Figure - 1].

Nomoto et al[3] demonstrated some degree of improvement in retinal circulation after RON, in eyes which developed CRA using indocyanine green videoangiography and image analysis, while most eyes without postoperative CRA did not show improvement in retinal circulation. We have demonstrated statistically significant improvement in postoperative vision and clinical improvement of varying degree in all the cases upon fundus examination, retinal photography and angiography. We have stated that RON procedure, as modified by us may possibly work by a combination of different mechanisms including improved retinal blood flow. Vitrectomy and posterior hyaloid peeling have been shown experimentally to decrease macular oedema. We also utilised passive aspiration of retinal haemorrhages and squeezing effect of mechanical pressure of liquid perfluorocarbon to augment surgical results.

The average duration of symptoms at the time of surgery in our series was 37.88 days (range 15-60 days, median: 34.5, SD:15.19). Seven patients presented with less than 30 days duration. The average vision improvement in this sub-set is 0.2, as compared to 0.1 in all cases, as pointed out. In theory, we do believe that RON, performed at the earliest in the group of patients which meet our selection criteria is very useful in avoiding irreversible retinal damage; however because of small numbers no scientific statement can be made. A future larger, comparative study would help to clarify this matter.

We agree that intravitreal triamcinolone acetonide has been found to decrease the macular oedema and improve best corrected visual acuity in CRVO. However, we have not compared this procedure with RON, therefore we cannot comment.



 
  References Top

1.
Garciia-Arumii J, Boixadera A, Martinez-Castillo V, Castillo R, Dou A, Corcostegui B. Chorioretinal anastomosis after radial optic neurotomy for central retinal vein occlusion. Arch Ophthalmol 2003;121:1385-91.  Back to cited text no. 1
[PUBMED]  [FULLTEXT]  
2.
Friedman SM. Opthociliary venous anastomosis after radial optic neurotomty for central retinal vein occlusion. Ophthalmic Surg Lasers Imaging 2003;34:315-7  Back to cited text no. 2
[PUBMED]    
3.
Nomoto H, Shiraga F, Yamaji H, Kageyama M, Takenaka H, Baba T, Tsuchida Y. Evaluation of radial optic neurotomy for central retinal vein occlusion by indocyanine green videoangiography and image analysis. Am J Ophthalmol 2004;138:612-9.  Back to cited text no. 3
[PUBMED]  [FULLTEXT]  


    Figures

  [Figure - 1]



 

Top
 
 
  Search
 
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
    Access Statistics
    Email Alert *
    Add to My List *
* Registration required (free)  

 
  In this article
References
Article Figures

 Article Access Statistics
    Viewed2746    
    Printed115    
    Emailed0    
    PDF Downloaded121    
    Comments [Add]    

Recommend this journal