Comparison of surgical treatments for central retinal vein occlusion; RON vs. cannulation of tissue plasminogen activator into the retinal vein.

Abstract

To compare the surgical outcomes and evaluate the effectiveness of two treatments for central retinal vein occlusion: radial optic neurotomy (RON) and cannulation of tissue plasminogen activator (tPA) into the retinal vein (tPA). This study consisted of 22 eyes. The inclusion criterion was a best-corrected visual acuity of < or =20/60 due to central retinal vein occlusion. The exclusion criteria were previous treatment and the presence of ocular neovascularization. Patients were randomized into RON or tPA groups (n = 11 each). Best-corrected visual acuity, macular thickness, and complications were recorded. The mean best-corrected visual acuity changed from 16/200 at baseline to 20/167 at 12 months in RON (P = 0.217) and from 10/200 to 20/200 in tPA (P = 0.051). The preoperative macular thicknesses decreased from 1,059 microm to 406 microm 12 months postoperatively in RON (P < 0.001) and from 1,121 microm to 271 microm (P < 0.001) in tPA. Neovascular glaucoma developed in 2 eyes (18%) in RON and in 4 eyes (40%) in tPA. Visual field defects associated with surgery were seen in 2 eyes (18%) in RON. There was no significant difference in surgical outcomes between the two procedures. Although best-corrected visual acuity and macular edema improved, the incidence of neovascular glaucoma was high. It is, therefore, still uncertain whether these treatments are effective.