There may be a new treatment regimen for patients with central retinal vein occlusions (CRVO).  The new regimen is actually of two previously described techniques; optic neurotomy combined with intraocular injection of steroid.

The study, described in a recent issue of Ophthalmic Surg lasers Imaging, compared the use of radial optic neurotomy (RON) plus intravitreal injection of steroid (triamcinolone) against four other arms;

• RON + Triamcinolone
• Triamcinolone Alone
• Internal Limiting Membrane Peel, RON and Triamcinolone
• RON Alone
• Observation only

The study results indicated the best improvement with the radial optic neurotomy when combined with the steroid injection.

What Does This Mean?  Radial optic neurotomy (RON) was popular for several years for the treatment of CRVO.  It has fallen out of favor, probably due to the lack of significant improvement (in my opinion).  While it was exciting to be able to offer hope to CRVO patients, the results were somewhat inconsistent and disappointing.

During that time, the use of intraviteal steroid injection was controversial.  By creating the radial neurotomy, basically making an incision on the edge of the nasal disc, penetrating choroid and lamina, the hope was to create an anastomosis with secondary neovascularization during the post-period.

The use of the steroid was feared to inhibit the neovascularization.

While any hope for this group of patients is welcomed, perhaps we need to revisit this procedure and the use of steroid.  With the introduction of Ozurdex, I wonder if used alone, or with RON, the visual prognosis may be brighter.

Randall V. Wong, M.D. ^[1]
Retina Specialist
Fairfax, Virginia