BackgroundRetinal branch vein occlusion (BVO) is the second most common retinal vascular disease after diabetic retinopathy. Many treatments for this disorder were attempted before 1977, but none were proven to be effective. The only treatment that seemed at all promising in preventing visual loss from BVO was laser photocoagulation.
DescriptionApproximately 500 patients were enrolled in the study. One-half were randomly assigned to treatment with argon laser photocoagulation; the other one-half remained untreated as controls. For BVO with or without neovascularization, scatter treatment of 100 to 400 laser burns was applied in the drainage area of the occluded vein site, avoiding the fovea and optic disc. Individual laser burns were 200 to 500 microns in diameter with an exposure time of 0.1 to 0.2 seconds. For macular oedema, burns of 50 to 100 microns in diameter with exposure time of 0.05 to 0.1 seconds were used. A fluorescein angiogram less than 1 month old had to have been available for each patient. Treatment was performed under topical anesthesia using the argon laser to achieve a grid pattern over the area of capillary leakage identified by fluorescein in the macular region. Photocoagulation was extended no closer to the fovea than the edge of the foveal avascular zone and did not extend peripherally beyond the major vascular arcade. The efficacy of treatment was judged on the basis of visual acuity measurements as well as assessment of the subsequent development of neovascularization and/or vitreous hemorrhage. Patients were followed for at least 3 years.
Patient EligibilityPatients with three types of diagnoses were accepted:
(1) major BVO without neovascularization;
(2) major BVO with neovascularization;
(3) BVO with macular oedema and reduced vision.
All patients must have had onset of signs and/or symptoms of BVO less than 18 months before the initial visit, vision of 5/200 or better, and sufficient clarity of the ocular media to permit confirmation of the condition with fundus photography. Other eligibility criteria apply to each of the three major groups as well as special cases such as the occurrence of bilateral disease.
ResultsResults from this 8-year study indicated that use of argon laser photocoagulation can benefit those afflicted with certain types of BVO, a retinal vascular disease that is second only to diabetic retinopathy in frequency.
The results indicated that argon laser treatment improves sight significantly in patients who already have reduced vision due to a complication of BVO called macular oedema, or swelling (the macula is the area in the retina used for sharp focusing and fine details). In addition, laser will significantly reduce the likelihood of vitreous hemorrhage.
The proven effective use of laser in treatment of BVO was especially significant because the retina cannot be replaced or transplanted if damaged by the condition.