Surgical Technique | Surgeon's Corner

Endovascular Cannulation With a Microneedle for Central Retinal Vein Occlusion

Kazuaki Kadonosono, MD; Shin Yamane, MD; Akira Arakawa, MD; Maiko Inoue, MD; Tadashi Yamakawa, MD; Eiichi Uchio, MD; Yasuo Yanagi, MD; Shiro Amano, MD
JAMA Ophthalmol. 2013;131(6):783-786. doi:10.1001/jamaophthalmol.2013.2585.
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We developed a new surgical treatment in which a microneedle is used for retinal endovascular cannulation to treat eyes with central retinal vein occlusion by flushing thrombus out of the central retinal vein as it passes through the lamina cribrosa. The eyes of 12 consecutive patients (12 eyes) with central retinal vein occlusion were successfully treated using this novel treatment. At 24 weeks after surgery, 9 of 12 eyes had gained more than 15 letters in best-corrected visual acuity, and the mean decrease in central foveal thickness was 271.1 μm. Few complications were observed. The microneedle is stiff and sharp enough to facilitate retinal endovascular cannulation in eyes with central retinal vein occlusion. This new technique is a promising treatment of macular edema due to central retinal vein occlusion.

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Figure 1. Retinal endovascular cannulation instrument. A, The instrument consists of a 50-μm microneedle and a 10-mL syringe with a viscous fluid injector. B, The microneedle has an outer lumen of 50 μm and is made of stainless steel (top). A 30-gauge needle is shown for comparison (bottom). The scale shows micrometers.

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Figure 2. Cannulated vein in an eye with central retinal vein occlusion. A, The microneedle has been inserted into a branch retinal vein, and then the vessel has been slightly pushed toward the optic disc. B, The streamline produced by successful flushing with balanced saline solution can be seen.

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Figure 3. Fundus photographs, angiographic images, and optical coherence tomography images of the eye in patient 3 with central retinal vein occlusion before and after endovascular treatment. The retinal hemorrhages and soft exudates observed before surgery (A) have decreased markedly at 6 weeks after surgery (B). Comparison with the preoperative fluorescein angiographic image (C) shows less dilated retinal veins, improvement in vascular leakage, and reconstructed macular vasculature (D). A decrease in the avascular area and the presence of a perifoveal capillary network are seen at 6 weeks after surgery. The postoperative optical coherence tomography image (F) shows a marked decrease in macular edema compared with the preoperative optical coherence tomography image (E).




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