Surgical induction of chorioretinal venous anastomosis in ischaemic central retinal vein occlusion: a non-randomised controlled clinical trial.

AIM: To evaluate the safety and efficacy of surgical induction of chorioretinal venous anastomosis in the management of ischaemic central retinal vein occlusion (CRVO).

METHODS: In a comparative clinical trial, 28 patients with ischaemic CRVO were included, of whom 18 who declined surgery were considered as controls. The 10 surgical cases underwent standard vitrectomy with incisions into the choroids adjacent to the partially cut major retinal veins. Mersilene suture insertion was done to induce chorioretinal venous shunt. Mild endolaser was applied. Patients were followed up for 6-18 (mean 10) months.

RESULTS: Clinical success in shunt development was 90%. Surgical cases had a significantly better visual acuity improvement compared with controls (mean difference: 1.5 logMAR, p = 0.001) with 80% of them showing improvement (compared with 28% of the controls, p = 0.016). Neovascularisation developed in 39% of the control group compared with 0% of the surgical cases (p = 0.03). In multivariate analysis, surgery remained the sole significant predictor of visual improvement. There were three re-operations for vitreous cavity haemorrhage, cataract, and retinal detachment.

CONCLUSIONS: Surgical induction of chorioretinal venous anastomosis may result in visual acuity improvement and prevent neovascularisation in ischaemic CRVO. Randomised studies are needed to compare the current study modality with the natural course of CRVO and emerging procedures, such as optic neurotomy, in the management of ischaemic CRVO.