INTRAVITREAL INJECTION OF TISSUE PLASMINOGEN ACTIVATOR FOR CENTRAL RETINAL VEIN OCCLUSION*

Purpose: This pilot study evaluated the feasibility of intravitreal injections of tissue plasminogen activator (tPA) in eyes with central retinal vein occlusion (CRVO). Methods: Between August 1997 and October 2000, 9 eyes with CRVO were treated with intravitreal injection of tPA, 100 g (50 g/0.1mL), and paracentesis. After the injection, each patient was placed at strict bed rest in the supine posi-tion for 6 hours. Each patient was administered one baby aspirin daily. Best corrected visual acuity with Light House charts was obtained at each visit. A change of 3 or more lines of vision from pretreatment levels at 6 months ’ follow-up or a change in one level (ie, counting fingers to hand motions) was deemed significant. Results: All patients were followed up for at least 6 months. Four of 9 eyes (44%) showed 3 or more lines improvement at 6 months. In this group, the average improvement was 7 lines. Two eyes showed 6 or more lines loss of vision at 6 months. Four eyes showed dramatic improvement in visual acuity within 1 month of injection. There were no adverse effects related to treatment. Three eyes subsequently developed retinal or anterior-segment neovascularization requir-ing panretinal photocoagulation; all were graded as ischemic CRVO on fluorescein angiography at baseline. Conclusion: Intravitreal tPA can be injected safely and easily. Local injection of tPA should spare the patient the seri-ous systemic risks of intravenous tPA administration, such as stroke. Given the morbidity of CRVO, further investiga-tion with this therapy to establish both efficacy and safety seems warranted. Tr Am Ophth Soc 2001;99:219-22