Jornal de Oftalmologia Clínica e Experimental
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Efficacy of Intravitreal Injection of Tissue Plasminogen Activator on Improvement of Visual Acuity and Decreasing the Rate of Complications in Retinal Vein Occlusion

Ahmad Mirshahi, Mahnaz Abdollahian, Alireza Lashay, Abed Namavari, Hooshang Faghihi and Mahdi Nili

Purpose: to evaluate the effect of Intravitreal tissue plasminogen activator (r-tPA) injection on improvement of visual acuity and decreasing the rate of complications in Branch Retinal Vein Occlusion (BRVO) and ischemic Complications in Retinal Vein Occlusion (CRVO).
Methods: 10 patients with BRVO and 19 patients with ischemic CRVO of recent onset (from 4 to 30 days duration) and visual acuity of <=20/50 were given 100 microgram of tPA intravitreally. Ischemia was defined as an area of nonperfusion >=10 DD for CRVO and >=5 DD for BRVO. Follow up schedule contained 6 visits : at the time of injection, and 1 week,1 month, 2months, 3months, and 6 months after. Fluorescein angiography was performed before injection and at the end of the study.
Results: In ischemic CRVO group: only one eye (5.6%) developed Iris neovascularization. The mean of baseline visual acuity increased from 1.8400 LogMAR to 1.5333 LogMAR at the end of the study (p=0.009). Pearson correlation coefficient was +0.874 for initial and final measured BCVAs. 8 patients (44.4%) had doubling of visual angle (0.3 LogMAR increase in BCVA).
In BRVO group: 3 patients (30%) were classified in the ischemic group and after a complete 6 month follow up none of the cases (0%) developed retinal neovascularization, vitreous hemorrhage, retinal detachment or endophthalmitis. The mean of baseline visual acuity increased from 1.0710 LogMAR to 0.6100 at the end of the study (p=0.001).
Discussion: Comparison between the results of our study and natural history of RVO indicates that after injection: There was doubling of visual angle in about 10% of cases. The rate of Iris neovascularization and neovascular glaucoma was decreased to 1/6 of what occurs without treatment.
Endophthalmitis, retinal detachment and vitreous hemorrhage which are known as major complications of this procedure did not occur in any of our 29 patients.