Vitreous surgery of arterial and venous retinovascular diseases

Abstract

Retinal vascular occlusions are traditionally considered major causes of ocular morbidity due to their drastic impact on central visual function. Modern ophthalmology has introduced an array of new therapeutic modalities that are being tested through clinical trials with promising results. Therapies such as anti-vascular endothelial growth factors, VEGF receptor binding agents, and steroid pharmacotherapy are rapidly evolving to replace traditional conservative treatment and laser therapy. While pharmacologic therapy will probably be the gold standard of practice in the near future, modern vitreoretinal surgery offers important treatment options that would complement pharmacotherapy. Surgical embolectomy for retinal arterial occlusions and radial optic neurotomy and sheathotomy for retinal vein occlusions are techniques that have long been regarded intimidating. Refined instrumentation and better vitrectomy viewing systems greatly reduce the surgical risk of these procedures and make them feasible for most vitreoretinal surgeons, thereby rendering them effective backup options in those patients in whom pharmacotherapy carries a guarded prognosis.