TABLE 5.
Summary of studies evaluating the treatment of macular edema in BRVO by sheathotomy (VA = visual acuity, ME = macular edema, ILM = internal limiting membrane)
| Author | Study type | Patients | Follow-up (mean) | Outcomes | Comments |
|---|---|---|---|---|---|
| Osterloh and Charles75 | Case report. | 1 eye. | 8 months. | VA improved from 20/200 to 20/25. | First report of sheathotomy. |
| Garcia-Arumi et al.76 | Prospective interventional nonrandomized study. | 40 eyes—all underwent vitrectomy, sheathotomy and injection of 25 mg of tissue plasminogen activator into occluded vein. | 13 months. | Thrombus release in 11 eyes (27.5%)—correlated with early surgery. VA increased from 20/100 to 20/40 (p = 0.016). | |
| Yamamoto et al.77 | Retrospective interventional comparative case series. | 20 eyes—sheathotomy 16 control eyes (posterior vitreous detachment via vitrectomy). | 12 months. | VA: significantly better in both groups (p = 0.008 and p = 0.001, respectively). VA and foveal thickness were not significantly different between the groups. | |
| Charbonnel et al.78 | Prospective nonrandomized, interventional case series. | 13 eyes—sheathotomy. | 7 months. | Improvement in VA ≥ 2 ETDRS lines in 9 eyes (69%). | Absence of previous posterior vitreous detachment correlated with improvement in VA. |
| Sohn et al.79 | Retrospective interventional case series. | 22 eyes—sheathotomy + ILM peeling in all eyes. | 3 months. | Improvement in VA (log MAR) from 0.79 ± 0.29 to 0.57 ± 0.33 (p < 0.01). | All eyes pretreated with grid laser or triamcinolone. |
| Kumagai et al.80 | Prospective, randomized, comparative, interventional study. | Group 1: 18 eyes—sheathotomy. Group 2: 18 controls (vitrectomy without sheathotomy). | 31 months. | VA (log MAR) in group 1: 0.52 → 0.08. In group 2: 0.53 → 0.014. Differences between group 1 and 2 was not significant. | |
| Avci et al.81 | Retrospective interventional comparative case series. | 11 eyes—sheathotomy. 10 control eyes—grid laser photocoagulation. | 9 months. | VA (log MAR): sheathotomy: 0.84 → 0.36. Grid laser: 1.06 → 0.82. Difference was significant. | |
| Horio et al.82 | Interventional case series. | 7 eyes. | 6 months. | Significant improvement in retinal blood flow (p < 0.01) and reduced macular thickness (p = 0.03). | |
| Lakhanpal et al.83 | Retrospective interventional case series. | 12 eyes. | 49.9 weeks. | VA (logMAR) improved from 1.00 ± 0.32 to 0.56 ± 0.28 (p = 0.0003). | 25-gauge transvitreal limited arteriovenous crossing manipulation without vitrectomy. |
| Mester et al.84 | Prospective interventional nonrandomized case-control study. | 43 eyes—sheathotomy. 16 eyes additionally + ILM peeling. 25 control eyes. | 6 weeks. | 26 patients (60%) gained ≥ 2 lines of VA. Better result in patients with ILM peeling. ME and intraretinal hemorrhage resorbed in all patients. | All patients had isovolaemic hemodilution for 10 days. |
| Opremcak et al.85 | Prospective interventional case series. | 15 eyes. | 6.5 years. | Snellen VA improved in 10 patients (67%) by an average of 4 lines vision (range 1–9 lines). In 3 patients resolution of ME but no improvement of VA. | Retinal vascular bleeding in 2 patients. |
| Asensio Sanchez et al.86 | Prospective interventional nonrandomized study. | 13 eyes—sheathotomy, 5 eyes underwent additionally ILM peeling. | 12 months. | VA improved in 12 patients (92%). Better results in patients with ILM peeling. | |
| Lerche et al.87 | Prospective nonrandomized intervention case series. | 12 eyes – sheathotomy. | 3 months. | VA (logMAR) improved from 0.74 to 0.56. | |
| Mason et al.88 | Prospective, nonrandomized, comparative interventional study with concurrent control group. | 20 eyes—sheathotomy. 20 control eyes (10 of them without intervention and another 10 underwent grid laser). | 14 months (sheathotomy). 19 months (controls). | VA improvement: Sheathotomy: from 20/250 to 20/63. Controls: from 20/180 to 20/125 (p = 0.02). 45% of the surgical group had final VA ≥ 20/40 compared with 15% of the controls. | Data only for whole control group together. |
| Cahil et al.89 | Retrospective non-controlled case series. | 27 eyes—sheathotomy. | 12 months. | Resolution of ME in 8 (29.6%) patients, reduction in 14 (51.8%) and persistence in 5 (18.5.%). | |
| Becquet et al.90 | Prospective nonrandomized interventional case series. | 6 eyes (sheathotomy + ILM peeling. 6 controls (ILM peeling only). | 6 months. | Significant improvement of VA in both groups. No difference in VA or foveolar thickness between the groups (p = 0.5; p = 0.6 respectively). | |
| Martinez-Soroa et al.91 | Retrospective interventional case series. | 17 eyes—sheathotomy. | 6 months. | Improvement in VA from 0.26 to 0.4. 53% patients improved ≥ 4 lines (Snellen). | |
| Le Rouic92 | Retrospective interventional case series. | 3 eyes—sheathotomy. | 10 months. | No improvement in VA observed. | All patients with initial VA < 20/40. |
| Dotrelova et al.93 | Retrospective interventional case series. | 3 eyes—sheathotomy. | 12 months. | VA improved in 2 patients to 20/40, in 1 patient stabilized (20/180). | |
| Shah et al.94 | Retrospective interventional case series. | 5 eyes—sheathotomy. | 6.5 years. | VA preoperative in all patients ≤ 20/200. Improved in 4 eyes from 20/30 to 20/70. 1 eye with counting fingers remained unchanged. | |
| Crafoord et al.95 | Retrospective interventional case series. | 12 eyes—sheathotomy. | 20 months. | VA improved in 9 eyes (75%), in 1 eye (8.3%) remained unchanged and deteriored in 2 eyes (16.7%). | 2 patients received additionally 25 mg triamcinolone acetonide at the end of the surgery. |
| Han et al.96 | Retrospective interventional case series. | 20 eyes—pars plana vitrectomy and dissection of the arteriovenous crossing without separation of the vessels. | 10.5 months. | In 16 eyes (80%) improved VA ≥ 2 lines. Mean improvement of VA (logMAR) was = 0.44 ± 0.14 (p = 0.016). |