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In reply
In his letter, Dr Hayreh raises a number of interesting points related to our article, “Radial Optic Neurotomy for Management of Hemicentral Retinal Vein Occlusion,”1 based on his extensive research and clinical studies over the last several decades.
As described by Hayreh and Hayreh2 in an article on the natural history of 41 patients with HCRVO, around 16 (40%) of the cases had retinociliary collateral vessels at the time the condition was diagnosed and 29 (75%) showed collateral vessels during follow-up. Nevertheless, Hayreh and Hayreh do not specify the time of evolution of HCRVO at the initial examination; hence, some of the patients might have had visual symptoms for several months before the initial evaluation. Fuller et al3 found that cilioretinal collateral vessels appear spontaneously at around 6.7 months in patients with CRVO. In our experience of 20 cases of HCRVO1 diagnosed among 232 retinal vein occlusions, no patients had retinochoroidal anastomoses at the initial evaluation whereas 6 (46%) of the 13 patients with HCRVO who underwent surgery developed chorioretinal anastomoses following the procedure. The anastomotic vessels were at the site of the nasal neurotomy as early as 3 weeks postoperatively. In contrast, only 1 of the 7 patients who remained under observation showed chorioretinal anastomosis at the 6-month follow-up visit. In addition, the group of patients with retinochoroidal anastomoses in our series showed a tendency toward achieving a better mean final visual acuity (VA) than those without collateral vessels, although the differences were not statistically significant (P>.05).
Regarding the beneficial effect of RON, we believe that the collateral vessels induced by RON take part in decreasing macular edema. In the article by Hayreh and Hayreh,2 60% of the HCRVO cases had persistent macular edema whereas none of our patients had macular edema at 6 months1 ; of course, data from a longer follow-up are needed to draw definitive conclusions on this point. Another finding from our study is that improved VA was statistically related to the decrease in macular edema.1
As for the lumping together of ischemic and nonischemic HCRVO in our study, only nonischemic HCRVO cases were actually included. With respect to the selection criteria, only patients with VA worse than 20/60 underwent surgery because we believed that this group would benefit from the treatment whereas patients with better VA might spontaneously recover or maintain their VA status.
In the article by Hayreh and Hayreh,2 40% of the cases had VA of 20/25 or better at the initial examination, and this group of patients did not really improve; VA remained unchanged during follow-up. No patients with an established HCRVO in our experience had such good VA at the initial examination.
Among the 21 of 43 patients with initial VA less than or equal to 20/60 in the study by Hayreh and Hayreh,2 35 (86%) did not improve during follow-up (24 [78%] in the venous stasis group and 11 [92%] in the hemorrhagic retinopathy group). By comparison, in our series of similar patients treated with RON, 9 (69%) of the patients showed an improvement of 2 or more lines of Snellen VA. As a final comment, it is remarkable that the article by Hayreh and Hayreh completely lacks statistical analyses.2
Correspondence: Dr García-Arumí, Department of Ophthalmology, Instituto de Microcirugia Ocular, Universidad Autonoma de Barcelona, C/Munner No. 10, 08022 Barcelona, Spain (17215jga@comb.es).
Financial Disclosure: None reported.
Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature
Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal
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