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October 2004

The Question of Radial Optic Neurotomy inCentral Retinal Vein Occlusion—Reply

Arch Ophthalmol. 2004;122(10):1574-1575. doi:10.1001/archopht.122.10.1574

In reply

Dr Hayreh raises a number of interesting points based on his extensiveresearch and clinical studies during recent decades.

The ophthalmoscopic appearance and 10-disc areas of nonperfusion onfluorescein angiography have been accepted as the standard for ischemic centralretinal vein occlusion (CRVO) since the mid 1980s and were the criteria usedin the CRVO study.1 Angiographic criteriahave the advantage of forming a direct and measurable parameter for differentiatingischemic from nonischemic retinopathy. In our study, we evaluated the ophthalmoscopicappearance and 20-disc area of retinal capillary obliteration in 6 fieldsof 50° fundus photographs and angiographies to rule out ischemic cases.An afferent pupillary defect was observed in 4 patients (28.5%); however,they were considered nonischemic based on angiographic criteria. Regardingthe site of occlusion, Green et al2 histopathologicallystudied 29 eyes with CRVO, 5 of them postmortem and without neovascular glaucoma.In all 29 eyes, the thrombus was located anterior to, at the level of, orjust posterior to the lamina cribrosa. The assertion by Dr Hayreh that thesite of occlusion in nonischemic CRVO is at a variable distance posteriorto the lamina cribrosa has not yet been conclusively proven.