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Motohiro Kamei, Nagakazu Matsumura, Mihoko Suzuki, Susumu Sakimoto, Hirokazu Sakaguchi, Kohji Nishida; Reperfusion of ischemia with central retinal vein occlusion by activated protein C. Invest. Ophthalmol. Vis. Sci. 2013;54(15):4933. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
To present two cases of ischemic central retinal vein occlusion (CRVO) in which reperfusion of large ischemic areas occurred after a novel treatment with intraocular activated protein C (APC) injection.
We intravitreally injected 3 µg of APC to treat two men (ages, 62 and 60 years) diagnosed with ischemic CRVO. We evaluated the retinal perfusion using fluorescein angiography (FA) before and after treatment. The safety and efficacy of the treatment were evaluated.
In case 1, fluorescein angiography (FA) showed delayed retinal vascular filling and hypofluorescence due to non-perfusion of the retinal capillaries of 22.4 disc areas (DA). The area of non-perfusion decreased to 9.6 DA (by 57%) 3 months after treatment and completely resolved with almost normal microcirculation 10 months after treatment (Figure). In case 2, FA performed 6 months after treatment showed clearly improved microcirculation with shrinkage of the area of non-perfusion from 52.6 to 6.1 (by 88%). The treatment had no adverse effects and the visual acuity improved in both cases (20/400 to 20/250, and 20/300 to 20/150).
The current clinical report is the first to show that APC may be a potential treatment to achieve reperfusion of ischemic lesions. Although we reported only two cases, APC may be useful for treating not only ischemic CRVO but also other ischemic disorders such as diabetic retinopathy, acute myocardial infarction, or stroke.
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