Radial Optic Neurotomy: A New Surgical Approach for Glaucoma Treatment?
Medical hypothesis discovery and innovation in ophthalmology,
Vol. 1 No. 3 (2012),
1 September 2012
,
Page 52-56
Abstract
Glaucoma is a leading cause of blindness worldwide, characterised by specific visual field defects due to the degeneration of retinal ganglion cells and damage to the optic nerve head (ONH). Elevated intraocular pressure (IOP) is the most important risk factor for glaucoma development. One of the clinical hallmarks of glaucomatous optic neuropathy is the excavation of the ONH, which consists of a progressive posterior displacement of the ONH surface and excavation of the pre-laminar tissues beneath the anterior-most aspect of the scleral canal, known as the anterior scleral ring. Radial optic neurotomy (RON) is a surgical technique that has been proposed for treating central retinal vein occlusion. While the original rationale of RON was the relief of increased tissue pressure within the optic nerve that results from occlusion of the central retinal vein, recent results are discussed here which suggest that by relaxing of the scleral ring of the prelaminar and laminar regions of the ONH, RON may alleviate the IOP-related connective tissue stress, and in turn, prevent the onset and reduce the progression of glaucomatous neuropathy.
References
Downs JC, Roberts MD, Burgoyne CF. Biomechanics of the Optic Nerve Head. In: Dartt DA, Besharse J, Dana R, editors. Encyclopedia of the Eye, 2nd edition. Academic Press; 2010. p.183-201.
Ernest JT, Potts AM. Pathophysiology of the distal portion of the optic nerve. I. Tissue pressure relationships. Am J Ophthalmol. 1968 Sep;66(3):373-80. PMID: 5676350.
Burgoyne CF, Downs JC, Bellezza AJ, Suh JK, Hart RT. The optic nerve head as a biomechanical structure: a new paradigm for understanding the role of IOP-related stress and strain in the pathophysiology of glaucomatous optic nerve head damage. Prog Retin Eye Res. 2005 Jan;24(1):39-73. PMID: 15555526.
Yan DB, Coloma FM, Metheetrairut A, Trope GE, Heathcote JG, Ethier CR. Deformation of the lamina cribrosa by elevated intraocular pressure. Br J Ophthalmol. 1994 Aug;78(8):643-8. PubMed PMID: 7918293.
Yang H, Downs JC, Girkin C, Sakata L, Bellezza A, Thompson H, Burgoyne CF. 3-D histomorphometry of the normal and early glaucomatous monkey optic nerve head: lamina cribrosa and peripapillary scleral position and thickness. Invest Ophthalmol Vis Sci. 2007 Oct;48(10):4597-607. PMID: 17898283.
Bellezza AJ, Rintalan CJ, Thompson HW, Downs JC, Hart RT, Burgoyne CF. Deformation of the lamina cribrosa and anterior scleral canal wall in early experimental glaucoma. Invest Ophthalmol Vis Sci. 2003 Feb;44(2):623-37. PubMedPMID: 12556392.
Yang H, Thompson H, Roberts MD, Sigal IA, Downs JC, Burgoyne CF. Deformation of the early glaucomatous monkey optic nerve head connective tissue after acute IOP elevation in 3-D histomorphometric reconstructions. Invest Ophthalmol Vis Sci. 2011 Jan 21;52(1):345-63. PMID: 20702834.
Quigley HA, Addicks EM, Green WR, Maumenee AE. Optic nerve damage in human glaucoma. II. The site of injury and susceptibility to damage. Arch Ophthalmol. 1981 Apr;99(4):635-49. PMID: 6164357.
Roberts MD, Sigal IA, Liang Y, Burgoyne CF, Downs JC. Changes in the biomechanical response of the optic nerve head in early experimental glaucoma. Invest Ophthalmol Vis Sci. 2010 Nov;51(11):5675-84. PMID: 20538991.
Opremcak EM, Bruce RA, Lomeo MD, Ridenour CD, Letson AD, Rehmar AJ. Radial optic neurotomy for central retinal vein occlusion: a retrospective pilot study of 11 consecutive cases. Retina. 2001;21(5):408-15. PMID: 11642369.
Opremcak EM, Rehmar AJ, Ridenour CD, Kurz DE. Radial optic neurotomy for central retinal vein occlusion: 117 consecutive cases. Retina. 2006 Mar;26(3):297-305. PMID: 16508430.
Opremcak EM, Rehmar AJ, Ridenour CD, Kurz DE, Borkowski LM. Radial optic neurotomy with adjunctive intraocular triamcinolone for central retinal vein occlusion: 63 consecutive cases. Retina. 2006 Mar;26(3):306-13. PMID: 16508431.
GarcÃa-ArumÃi J, Boixadera A, Martinez-Castillo V, Castillo R, Dou A, Corcostegui B. Chorioretinal anastomosis after radial optic neurotomy for central retinal vein occlusion. Arch Ophthalmol. 2003 Oct;121(10):1385-91. PMID: 14557173.
Nagpal M, Nagpal K, Bhatt C, Nagpal PN. Role of early radial optic neurotomy in central retinal vein occlusion. Indian J Ophthalmol. 2005 Jun;53(2):115-20. PMID: 15976467.
Weizer JS, Stinnett SS, Fekrat S. Radial optic neurotomy as treatment for central retinal vein occlusion. Am J Ophthalmol. 2003 Nov;136(5):814-9. PMID: 14597031.
Zambarakji HJ, Ghazi-Nouri S, Schadt M, Bunce C, Hykin PG, Charteris DG. Vitrectomy and radial optic neurotomy for central retinal vein occlusion: effects on visual acuity and macular anatomy. Graefes Arch Clin Exp Ophthalmol. 2005 May;243(5):397-405. PMID: 15931541.
Weis E, Gan KD, Hinz BJ, Tennant MT, MacDonald IM, Greve MJ. A retrospective cohort study of radial optic neurotomy for severe central retinal vein occlusions. Can J Ophthalmol. 2008 Feb;43(1):73-8. PMID: 18204499.
Bynoe LA, Opremcak EM, Bruce RA, Lomeo MD, Ridenour CD, Letson AD, Rehmar AJ. Radial optic neurotomy for central retinal vein obstruction. Retina. 2002 Jun;22(3):379-80. PMID: 12055480.
Feltgen N, Herrmann J, Hansen L. [Visual field defect after radial optic neurotomy]. Ophthalmologe. 2005 Aug;102(8):802-4. PMID: 15221258.
Hayreh SS. Radial optic neurotomy for central retinal vein occlusion. Retina. 2002 Dec;22(6):827; author reply 827. PMID: 12476121.
Hayreh SS. Radial optic neurotomy for nonischemic central retinal vein occlusion. Arch Ophthalmol. 2004 Oct;122(10):1572-3. PMID: 15477486.
Williamson TH, Poon W, Whitefield L, Strothidis N, Jaycock P. A pilot study of pars plana vitrectomy, intraocular gas, and radial neurotomy in ischaemic central retinal vein occlusion. Br J Ophthalmol. 2003 Sep;87(9):1126-9. Erratum in: Br J Ophthalmol. 2003 Nov;87(11):1432. PMID: 12928281.
Burgoyne CF, Downs JC, Bellezza AJ, Hart RT. Three-dimensional reconstruction of normal and early glaucoma monkey optic nerve head connective tissues. Invest Ophthalmol Vis Sci. 2004 Dec;45(12):4388-99. PMID: 15557447.
Sigal IA, Ethier CR. Biomechanics of the optic nerve head. Exp Eye Res. 2009 Apr;88(4):799-807. PMID: 19217902.
Belforte N, Sande P, de ZavalÃa N, Knepper PA, Rosenstein RE. Effect of chondroitin sulfate on intraocular pressure in rats. Invest Ophthalmol Vis Sci. 2010 Nov;51(11):5768-75. PMID: 20574017.
Belforte N, Sande PH, de ZavalÃa N, Dorfman D, Rosenstein RE. Therapeutic benefit of radial optic neurotomy in a rat model of glaucoma. PLoS One. 2012;7(3):e34574. PMID: 22479647.
Schneider U, Inhoffen W, Grisanti S, Bartz-Schmidt KU. Characteristics of visual field defects by scanning laser ophthalmoscope microperimetry after radial optic neurotomy for central retinal vein occlusion. Retina. 2005 Sep;25(6):704-12. PMID: 16141857.
Samuel MA, Desai UR, Gandolfo CB. Peripapillary retinal detachment after radial optic neurotomy for central retinal vein occlusion. Retina. 2003 Aug;23(4):580-3. PMID: 12972785.
MartÃnez-Jardón CS, Meza-de Regil A, Dalma-Weiszhausz J, Leizaola-Fernández C, Morales-Cantón V, Guerrero-Naranjo JL, Quiroz-Mercado H. Radial optic neurotomy for ischaemic central vein occlusion. Br J Ophthalmol. 2005 May;89(5):558-61. PMID: 15834084.
Yamamoto S, Takatsuna Y, Sato E, Mizunoya S. Central retinal artery occlusion after radial optic neurotomy in a patient with central retinal vein occlusion. Am J Ophthalmol. 2005 Jan;139(1):206-7. PMID: 15652858.
Horio N, Horiguchi M. Central retinal vein occlusion with further reduction of retinal blood flow one year after radial optic neurotomy. Am J Ophthalmol. 2005 May;139(5):926-7. PMID: 15860308.
Belforte NA, Sande PH, Dorfman D, Croxatto JO, Rosenstein RE. Early histologic and functional study of radial optic neurotomy outcomes in normal rat eyes. Retina. 2011 Nov;31(10):2115-22. PMID: 21642899.
Downs JC, Roberts MD, Burgoyne CF. Mechanical environment of the optic nerve head in glaucoma. Optom Vis Sci. 2008 Jun;85(6):425-35. PMID: 18521012.
Pease ME, McKinnon SJ, Quigley HA, Kerrigan-Baumrind LA, Zack DJ. Obstructed axonal transport of BDNF and its receptor TrkB in experimental glaucoma. Invest Ophthalmol Vis Sci. 2000 Mar;41(3):764-74. PMID: 10711692.
Minckler DS, Bunt AH, Johanson GW. Orthograde and retrograde axoplasmic transport during acute ocular hypertension in the monkey. Invest Ophthalmol Vis Sci. 1977 May;16(5):426-41. PMID: 67096.
Johansson JO. Inhibition of retrograde axoplasmic transport in rat optic nerve by increased IOP in vitro. Invest Ophthalmol Vis Sci. 1983 Dec;24(12):1552-8. PMID: 6197389.
Morrison J, Farrell S, Johnson E, Deppmeier L, Moore CG, Grossmann E. Structure and composition of the rodent lamina cribrosa. Exp Eye Res. 1995 Feb;60(2):127-35. PMID: 7781741.
Albrecht May C. Comparative anatomy of the optic nerve head and inner retina in non-primate animal models used for glaucoma research. Open Ophthalmol J. 2008 May 9;2:94-101. PMID: 19516911.
May CA, Lütjen-Drecoll E. Morphology of the murine optic nerve. Invest Ophthalmol Vis Sci. 2002 Jul;43(7):2206-12. PMID: 12091418.
- Abstract Viewed: 3985 times
- Full text PDF Downloaded: 3074 times