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LA Bynoe, JN Weiss; Retinal Vascular Tissue Plasminogen Activator Injection for Anterior Ischemic Optic Neuropathy . Invest. Ophthalmol. Vis. Sci. 2002;43(13):1869.
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Purpose:Anterior ischemic optic neuropathy (AION) often causes severe and permanent loss of vision and is believed to be caused by posterior ciliary artery (PCA) insufficiency and/or occlusion of branches to the peripapillary choroidal circulation. We have previously reported that tissue plasminogen activator (t-PA) injected directly into the retinal venous system promotes improvement in retinal perfusion and recovery of visual acuity in retinal vascular occlusive disease. We report a new surgical technique in which a branch of the central retinal artery is cannulated and injected with t-PA to treat AION. Methods:Two eyes of 2 patients with AION underwent pars plana vitrectomy with cannulation and infusion of t-PA into a branch retinal artery to induce retrograde flow through the arterial system. This was then followed by t-PA injection into the retinal venous system. Results:In both cases, there was rapid resolution of optic nerve head edema. Case 1, a 58-year-old woman with a 1.5-week-old AION and 10/200 acuity recovered 8 lines of acuity to 20/63 at 6 weeks post-op, and later achieved 20/32 acuity at 2 months, and 20/20 acuity at 1 year. Case 2, a 72-year-old woman with a 6- month-old AION and temporal nerve head pallor, recovered from 5/200 preoperatively to 10/160 at 2 months postoperatively and was stable 6 months following the procedure. There were no intra- or postoperative complications. Conclusion:Our preliminary experience suggests vitrectomy with retinal vascular cannulation and infusion of t-PA may help improve the course of AION.
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