Visual field defects after radial optic neurotomy for central retinal vein occlusion

PURPOSE: Surgical decompression of the vein in central retinal vein occlusion (CRVO) by radial optic neurotomy (RON) was recently proposed as being surgically feasible, safe, and beneficial. The effect of RON on the visual field has not been systematically reported, although possible visual field defects are expected due to iatrogenic cutting of the optic nerve fibers. The authors report the results of visual field testing in patients who underwent RON at the Tel Aviv Medical Center. METHODS: Twelve consecutive patients (8 men, mean age of all patients 68 years) with nonperfused or indeterminate CRVO whose initial visual acuity (VA) was ≤20/400 underwent RON. Nine of these patients were able to perform visual field tests at 6 months post-RON and their visual field results are presented. RESULTS: VA improved by ≥3 lines in 5 patients (42%). Three (25%) patients had a final VA of ≥20/200 and another had a final VA ≥20/50. Fundus and VA improvement were relatively slow. Two patients had clearing of the intraretinal blood, resolution of the venous dilation, and improved VA at the 2-month follow-up visit. Temporal visual field defects consisting of temporal ones that could be correlated to the site of the RON incision were detected in five out of the nine patients who were able to perform visual field tests. No temporal visual field defects were found in the remaining four patients, and three other patients were unable to perform visual field tests due to inability to identify the largest target size. CONCLUSION: VA improvement in 5 of 12 patients with ischemic or indeterminate CRVO following RON may be better than the natural history of CRVO. The risk of visual field defects may, however, be heightened by possibly cutting off blood supply to the optic nerve head and possible damage to nerve fibers in the optic nerve head, both inherent to the surgical procedure and both likely to produce visual loss.