Elsevier

Ophthalmology

Volume 114, Issue 4, April 2007, Pages 716-723.e1
Ophthalmology

Original Article
Retinal Endovascular Lysis in Ischemic Central Retinal Vein Occlusion: One-Year Results of a Pilot Study

https://doi.org/10.1016/j.ophtha.2006.06.064Get rights and content

Purpose

Retinal endovascular lysis is a new therapeutic option for patients with central retinal vein occlusion (CRVO). In this procedure, a fibrinolytic agent is injected directly into a cannulated retinal vein after pars plana vitrectomy.

Design

Prospective interventional case series.

Participants

Thirteen strictly defined patients with ischemic CRVO.

Methods

Patients with a decimal visual acuity (VA) of 0.2 or worse were scheduled for surgery within the first 5 months after onset of CRVO. A full ocular examination, determination of VA (Early Treatment Diabetic Retinopathy Study charts), and fluorescein angiography were done preoperatively and 6, 12, 26, and 52 weeks postoperatively.

Main Outcome Measure

Visual acuity 1 year after retinal endovascular lysis. Secondary study end points were (1) correlation of VA and successful recombinant tissue plasminogen activator injection into a retinal vein, (2) complication rate, and (3) number of additional surgical procedures within the first year after retinal endovascular lysis.

Results

All patients had an ischemic CRVO and completed the 1-year follow-up visit. Preoperative decimal VA was 0.063 +0.025/−0.018 (VA range, light perception [LP]–0.2); 6-week postoperative VA, 0.049 +0.024/−0.016 (LP–0.4); 3-month postoperative VA, 0.043 +0.019/−0.014 (LP–0.3); 6-month postoperative VA, 0.035 +0.022/−0.013 (blindness–0.4); and 12-month postoperative VA, 0.04 +0.026/−0.016 (blindness–0.4). Visual acuity changed 1 year after retinal endovascular lysis by −1.923±1.619 lines (+6 to −16 lines; P = 0.258). We considered the retinal endovascular lysis procedure to have been technically successful in 10 eyes. Visual changes did not depend on successful lysis. Six eyes developed neovascular glaucoma, of which 2 globes ended up with painful phthisis and had to be removed. Retinal detachment was found in 3 eyes and cataract in 4. Together, the 13 eyes needed 22 additional surgical procedures. Preoperative and postoperative angiographic examinations showed no significant changes.

Conclusion

Ischemic CRVO patients did not profit from retinal endovascular lysis in this pilot study. Visual results and the risk of developing iris neovascularization and neovascular glaucoma took the natural course. Although these results may be due to the overall bad prognosis of these particular ischemic eyes, the number of postoperative complications is unacceptably high.

Section snippets

Patients and Methods

Between 2003 and 2005, patients with CRVO were screened for eligibility (see below) and consecutively included in the study.

Results

From August 2002 to March 2005, we prospectively enrolled 13 patients in the study. So far, all patients have completed the 1-year control. Patient characteristics are depicted in detail in Table 1.

Discussion

In the management of acute major vessel occlusion, the use of fibrinolytic agents such as recombinant tissue plasminogen activator is widely accepted. Today, the spectrum of indications for thrombolytic drugs comprises acute myocardial infarction, lung embolism, ischemic stroke, deep vein thrombosis, and acute arterial occlusions of the lower limbs. Based on the histopathological and clinical features of retinal vessel occlusion, fibrinolysis aiming at early restoration of blood flow appears to

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    Manuscript no. 2006-500.

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