29.
Vitrectomy vs. New Treatment Strategies in BRVO
Ulrich Mester, H. Kaymak (Sulzbach)
Over a long time period no significantly efficacious treatment for BRVO was available. The standard
therapy was isovolemic hemodilution with limited success. A new area of surgical intervention
was initiated by Osterloh and Charles in 1988, and gained worldwide interest after the
favourable results with arteriovenous sheathing published by Opremcak and Bruce in 1999.
Meanwhile numerous publications showed significantly functional and anatomical improvement
in BRVO after vitrectomy, vitrectomy combined with sheathotomy and/or ILM-peeling.
Therefore, the key factor of this surgery remains uncertain:
Decompression of the vein, improvement of oxygen supply, release of vitreous traction, or the
removal of a diffusion barrier in front of the macular?
A different and much easier approach to perform was the intravitreal injection of triamcinolone.
Several studies showed a reduction of the macular edema with improved visual outcome after this procedure. A
significant drawback of intravitreal triamcinolone is the high incidence of secondary glaucoma.
Based on the pathogenetic impact of VEGF in macular edema the intravitreal application of anti-VEGF drugs appears to be
more efficacious with less side effects. Several studies demonstrated a significant beneficial effect of Bevacizumab and
Ranibizumab in eyes with BRVO. On the other hand, this effect was not sustained in most cases, necessitating repeated injections.
These new treatment modalities enlarged our therapeutic armamentarium for BRVO. The therapy should be selected according
to the individual findings.