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Simultaneous intravitreal injection of triamcinolone acetonide and tissue plasminogen activator for central retinal vein occlusion: a pilot study
  1. Takuhiro Yamamoto,
  2. Motohiro Kamei,
  3. Kaori Sayanagi,
  4. Nagakazu Matsumura,
  5. Kentaro Nishida,
  6. Hirokazu Sakaguchi,
  7. Motokazu Tsujikawa,
  8. Yasuo Tano
  1. Department of Ophthalmology, Osaka University Graduate School of Medicine, Osaka, Japan
  1. Correspondence to Dr Motohiro Kamei, Department of Ophthalmology, E7, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita 565-0871, Japan; mkamei{at}


Purpose To evaluate the efficacy and safety of simultaneous intravitreal injection of triamcinolone acetonide (TA) and tissue plasminogen activator (tPA) for macular oedema associated with central retinal vein occlusion (CRVO).

Methods Twenty eyes of 20 patients with CRVO were enrolled. A mixture of TA (4 mg) and tPA (25 μg) was injected into the vitreous of 20 eyes with CRVO. Best corrected visual acuity (BCVA) and macular thickness before and 1, 3, 6 and 12 months after the procedure were measured.

Results The BCVA improved three lines or more in 65%, 55%, 55% and 53% of eyes and the mean macular thickness decreased from 1072 μm to 455, 450, 480 and 409 μm (p<0.001) at 1, 3, 6 and 12 months, respectively. Fifteen (75%) of the 20 eyes required at least one additional injection to prevent a recurrence of macular oedema. The intraocular pressure increased in four eyes.

Conclusion Overall, intravitreal injection of the TA/tPA mixture improved the BCVA by three lines or more in at least 50% of eyes and decreased the mean macular thickness at four time points without serious side effects. A randomised clinical trial is necessary to evaluate the efficacy of this treatment.

  • Triamcinolone acetonide (TA)
  • tissue plasminogen activator (tPA)
  • central retinal vein occlusion (CRVO)
  • vitreous, retina
  • macula
  • treatment medical

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  • Competing interests None.

  • Patient consent Obtained.

  • Ethics approval This study was conducted with the approval of the Institutional Review Board of Osaka University. The study was performed according to the tenets of the Declaration of Helsinki.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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