Grid Pattern Photocoagulation for Macular Edema in Central Vein Occlusion

The Central Vein Occlusion Study (CVOS) was a randomized, controlled, clinical trial to determine whether treatment with macular grid photocoagulation improved or preserved visual acuity in eyes with macular edema involving the fovea secondary to nonischemic central retinal vein occlusion (CRVO) and best corrected visual acuity of 20/50 or worse. The study found that, overall, visual acuity results were not different for treated and control eyes. Based on this, the standard of care at that time continued to be observation. (Treatment with intravitreal anti–vascular endothelial growth factor [VEGF] agents is now the standard of care.)

Surgical reconstruction of central venous obstruction in salvaging upper extremity dialysis accesses

Background Central vein thrombosis or obstruction is a common complication associated with central venous catheters placed for intermittent hemodialysis. The reported outcomes of percutaneous catheter-based interventions reveal high rates of lesion recurrence with varying and frequently limited patency intervals. We present the case of open venous bypass in the treatment of catheter-associated chronic central vein occlusion. Methods We report a case of symptomatic arm swelling secondary to central vein stenosis and failed endovascular venous intervention treated by central vein bypass with prosthetic graft through median sternotomy. Results Patient had an open axillary to innominate venous bypass via median sternotomy incision, which resulted in resolution of patient's symptoms and uninterrupted patency of the pre-existing vascular access. Conclusions Open venous bypass is a reliable alternative to endovascular intervention in the symptomatic patient with extensive central vein occlusion as a primary intervention or in whom prior endovascular therapy has failed.