Sheathotomy
Ulrich Mester (Sulzbach)
After the first report about surgical decompression of branch retinal vein occlusion (BRVO) in
1988 by Osterloh and Charles this procedure gained renewed interest in the last five years
leading to several publications.
While most investigators reported on satisfactory results, some important questions are still
open:
What is the key factor for visual improvement, because the surgery consists of several procedures:
Pars plana vitrectomy, removal of the internal limiting membrane, and sheathotomy.
Each of these procedures alone may be sufficient to reduce macular edema and improve visual
acuity.
What is the appropriate surgical technique? Which instruments are useful for sheathotomy and
how extensive should the separation be performed?
What is the influence of ischemia on the functional outcome?
What duration of BRVO allows a successful surgical intervention?
Is intraocular triamcinolone application an alternative or a rational additional treatment?
How compare the results of sheathotomy with hemodilution?
Some of these questions are discussed with the literature and the personal experience of more than 180 surgeries performed
since 2003.