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JN Weiss; Retinal Endovascular Surgery for Retinal Vascular Occlusion . Invest. Ophthalmol. Vis. Sci. 2002;43(13):1875.
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© ARVO (1962-2015); The Authors (2016-present)
Purpose:We have previously reported that tissue plasminogen activator (t-PA) injected directly into the retinal venous system for central and hemispheric retinal vein occlusions (CRVO and HRVO, respectively) promotes improvement in retinal perfusion and recovery of visual acuity. We now report the updated results of our prospective, non-comparative, interventional case series. Methods:One hundred six eyes (94 with CRVO, average occlusion age = 4.5 months; 12 eyes with HRVO, average occlusion age = 3 months) underwent pars plana vitrectomy with cannulation and infusion of t-PA into a retinal vein. The main outcome measure was recovery of visual acuity. Results:Fifty two of 94 CRVO patients (55%) recovered at least 3 lines of acuity within 3 months following the procedure and 23 (24%) recovered at least 6 lines. For HRVO, 8 of 12 (67%) recovered at least 3 lines and 3 (25%) recovered at least 6 lines. Postoperative complications included retinal detachment (3.8%), vitreous hemorrhage (15%), and rubeosis (11%). We also identified 12 eyes in which there was dramatic clearance of retinal hemorrhage that either did not recover acuity or lost some recovered acuity secondary to cataract formation (5 eyes), postoperative macular edema (7 eyes) or both (1 eye). Subsequent cataract surgery (2 eyes) or intravitreal triamcinolone injection (3 eyes) tended to promote visual recovery in such cases. Conclusion:Vitrectomy with retinal vein cannulation and infusion of t-PA is a relatively safe procedure that improves vision in patients with CRVO and HRVO. Intravitreal kenalog injection may be a useful adjunctive treatment in eyes with decreased acuity secondary to persistent or new macular edema that appear to have improved retinal perfusion following retinal endovascular surgery.
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