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In the July 2006 issue of the ARCHIVES, D’Amico et al1 review their experiences with transvitreal optic disc puncture for central retinal vein occlusion. The trial was limited to patients aged 65 years or older and to eyes with a visual acuity of 20/200 or less.
D’Amico and colleagues concluded that their surgical procedure had not effectively restored visual acuity.
The ophthalmoscopic and angiographic findings of central retinal vein occlusion vary to a considerable degree. Sometimes the venous tortuosity and dilation are mild and only a few hemorrhages are scattered throughout the fundus. For such eyes, the central retinal vein is not occluded—it is obstructed, however slightly. For other eyes, the venous obstruction is paramount—occluded in many instances. The fundus is markedly congested. For still other eyes, capillary nonperfusion becomes the distinguishing feature. Diminished arterial perfusion has developed in addition to venous obstruction.
The study by D’Amico and colleagues can be questioned with regard to their enrollment of patients. The only angiogram that was included in the article shows an eye with capillary nonperfusion throughout most of the fundus. The retinal veins exhibit little if any tortuosity.
Subjects demonstrating such dire findings should surely be delegated to some other study group. Visual improvement cannot be obtained for an eye with severe macular capillary nonperfusion. Did D’Amico and colleagues think that nerve head puncture could relieve not only the venous obstruction component but also the arterial insufficiency that had developed from, one can surmise, longstanding hypertensive arteriosclerosis? And if so, did they think that capillary perfusion within the macula could be restored and visual acuity improved? An eye with no chance of visual improvement compromises the results negatively because visual assessment was the criterion by which the surgical procedure was judged.
D’Amico and colleagues could have provided more useful information, perhaps, if they had divided their series into a congestive type and an ischemic type.
Correspondence: Dr Hawkins, Retina-Vitreous Associates, 1200 Binz, Suite 400, Houston, TX 77004 (office@rvahouston.com).
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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