Does radial optical neurotomy have a place in the treatment of central retinal vein occlusion?

Background: the goal is to evaluate the anatomical (macular edema) and functional (visual acuity) efficacy of radial optic neurotomy in central retinal vein occlusion.

Methods: the retrospective study is dealing with 15 eyes treated with radial optic neurotomy and at least a 6-month follow-up. The main study parameters are the visual acuity, the characteristics of the vein occlusion with fluorescein angiography, and those of the macular edema with optical coherence tomography.

Results: mean preoperative visual acuity was 0.07 (0.003-0.4). At 6 months, mean visual acuity was 0.12 (0.003-0.3) for 14 cases, one eye being blind. Visual acuity was improved in 4 cases (26%), deteriorated in 2 cases and equal in 9 cases. Preoperative fluorescein angiography showed a perfused form in 9 cases and an ischemic one in 6 cases. At 6 months, fluorescein angiography was available in 12 out of the 15 cases. It showed ischemia in 4 cases, macular edema in 4 cases, a scarred macula in 2 cases. The posterior pole was hidden by blood in the last 2 cases. Optical coherence tomography was performed preoperatively and at 6 months in 8 out of the 15 cases. It showed macular edema in every case preoperatively. At 6 months, there was a worsening in 2 cases (25%), an improvement in 4 cases. In 2 cases, edema was replaced by a macular scar.

Conclusions: at 6 months, this study shows any improvement of the visual acuity in 26% of the cases. This result does not allow us to conclude that optical radial neurotomy has any role to play in the treatment of central retinal vein occlusion.