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Motohiro Kamei, Susumu Sakimoto, Nagakazu Matsumura, Mihoko Suzuki, Hirokazu Sakaguchi, Kohji Nishida; INTRAVITREAL ACTIVATED PROTEIN C INJECTION AS A NOVEL TREATMENT FOR ISCHEMIC CENTRAL RETINAL VEIN OCCLUSION. Invest. Ophthalmol. Vis. Sci. 2014;55(13):3869.
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To report the 1-year results of an intravitreal injection of activated protein C (APC) in patients with severe macular edema due to ischemic central retinal vein occlusion (CRVO).
Freeze-dried, concentrated human APC (Anact C®, Teijin/Chemo-Sero-Therapeutic Research Institute, Japan), was dissolved in an intraocular irrigation solution and prepared at a concentration of 60 μg/ml. A 3-μg intravitreal injection of APC in 0.05 ml was given to patients with severe ischemic CRVO. Patients underwent Snellen VA testing, optical coherence tomography imaging, fluorescein angiography (FA), and ophthalmoscopic examination at baseline and follow-up visits.
Ten patients (mean age, 73.9 years) were eligible for this study. No adverse events, including endophthalmitis, clinically evident inflammation, increased intraocular pressure, retinal tears, or retinal detachments, have developed in any patient. The mean baseline central macular thickness was 895 μm and decreased to a mean of 219 μm at month 24 (p<0.001). The mean baseline VA was 8/200 (logMAR, 1.39) and the mean final VA was 20/200 (logMAR, 0.97) (P=0.004). A VA improvement occurred in 6 of the 10 eyes. Surprisingly, complete reperfusion in the non-perfusion areas was observed on FA in 3 patients at one year after the treatment. Iris neovascularization occurred in 3 patients, which was successfully treated with laser photocoagulation or trabeculectomy.
Intravitreal APC showed a decrease in macular edema and improved VA in some cases of severe ischemic CRVO. The intravitreal APC did not reveal any safety concerns. These results suggested that intravitreal injections of APC might be an alternative treatment option for ischemic CRVO. APC also might support vascular reconstruction.
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