Intravitreal Injection of Tissue Plasminogen Activator for Central Retinal Vein Occlusion

Abstract

Abstract: : Purpose:To determine the efficacy of intravitreal injection of tissue plasminogen activator (tPA) to resolve the macular edema (ME) due to a central retinal vein occlusion (CRVO). Methods: Eight eyes of 8 patients with CRVO–associated ME were treated with an intravitreal injection of tPA. The estimated duration of symptoms ranged from 2 to 12 weeks (mean 7 weeks). The tPA (40,000 units of monteplase) was injected into the vitreous cavity through the pars plana by a 30G needle following paracentesis. Best–corrected visual acuity (BCVA), OCT–determined foveal thickness, fluorescein angiography, and electroretinography (ERG) to full–field stimuli were measured before and 1 week, 1 and 2months after tPA. Results:BCVA was improved by more than 2 lines in 5 eyes (63%) and remained stable in 3 eyes (37%) at 1 month postoperatively. Postoperatively, the ME was markedly reduced in all eyes. The preoperative mean foveal thickness was 686 µm, and was significantly reduced to 354 µm at 1 week, 412 µm at 1 month and 418 µm at 2 month postoperatively. The b–wave amplitudes of the scotopic and photopic ERGs were significantly increased 1 month after tPA in 2 of 3 eyes in which full–field ERGs were examined. No complication due to the tPA injection was experienced.Conclusions: The intravitreal injection of tPA may be effective for ME associated with a CRVO and may also improve the ERGs. Further investigation is needed for tPA to show the advantage over the natural course.

Keywords: retina • macula/fovea • imaging methods (CT, FA, ICG, MRI, OCT, RTA, SLO, ultrasound)