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A. Skaf, Z. Ahmad, J. E. Puklin, T. H. Mahmoud; Effect of Early Tissue Plasminogen Activator versus Avastin on Central Macular Thickness and Visual Outcomes in Acute Retinal Vein Occlusions. Invest. Ophthalmol. Vis. Sci. 2010;51(13):3568.
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© ARVO (1962-2015); The Authors (2016-present)
To compare the role of early intravitreal injection of tissue plasminogen activator (tPA) with subsequent intravitreal Avastin (IVA) and possibly intravitreal triamcinolone acetonide (IVTA) as needed to early intravitreal Avastin alone as needed in acute retinal vein occlusions (RVO). To study the effect of early intravitreal tPA on the rate of subsequent injections and the functional and anatomic outcomes in retinal vein occlusions.
A chart review was conducted of all patients who presented within 21 days of retinal vein occlusion, including CRVO, HRVO and BRVO, and were treated with intravitreal injections. Patients were divided into two groups, according to whether they received tPA (50 µg/0.1 ml) within 21 days. Other injections such as IVA (1.25 mg/0.05 ml) and IVTA (4 mg/0.1ml) were recorded in each group. Visual acuity (Va) and central macular thickness (CMT) measured with OCT were recorded at baseline and final follow up. Wilcoxon and Mann-Whitney signed rank tests were used for statistical analysis.
Six eyes of 6 patients, aged 54 to 78, 2 CRVO, 3 HRVO, and 1 BRVO, were included in the tPA group with a mean follow up of 6.6 months. Five eyes had a mean of 2.2 IVA (SD 2.5), and 2 of them had 1 IVTA. One required no additional injections due to favorable response. Mean Va improved from LogMar 1.29 (SD 0.45, ~20/400) to final 0.40 (SD 0.23, ~20/50) (p=0.03). Mean CMT decreased from 865 µm (SD 205) to 257 µm (SD 41) (p=0.03). Two eyes developed high IOP, both after IVTA, and 1 eye required glaucoma surgery. There were no cases of vitreous hemorrhage or new retinal hemorrhage after tPA. Seven eyes of 7 patients, aged 50 to 74, 4 CRVO, 1 HRVO, and 2 BRVO, were included in the non-tPA group with a mean follow up of 11.4 months, a mean of 8.1 IVA (SD 8.2), with no IVTA. Mean Va was stable with LogMar 0.62 (SD 0.42, ~20/80) and final 0.55 (SD 0.59, ~20/70) (p=0.45). Mean CMT decreased from 503 µm (SD 210) to 240 µm (SD 38) (p=0.02). One eye developed retinal neovascularization which was treated with panretinal photocoagulation.
Early intravitreal tPA with subsequent IVA may offer a reasonable treatment approach for acute RVO. Patients receiving early tPA injections had significantly improved Va, significantly decreased CMT and required fewer intravitreal injections compared to patients receiving IVA alone. There were no complications related to tPA injection.
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