Objectives: We investigated the efficacy of intravitreal tissue plasminogen activator (tPA) for the treatment of acute central retinal vein occlusion.
Design: Twenty-six eyes with central retinal vein occlusion (CRVO, n=23) and hemi-retinal vein occlusion (n=3) with recent onset of visual symptoms (< or = 21 days) were identified and given an intravitreal injection of 65 -110 microg of tPA.
Results: Among eyes with CRVO, visual acuity improved to > or = 20/40 in 7 of 23 patients (30.4%) at 6 weeks, and 8 of 23 patients (34.8%) at 6 months. Visual acuity improved or stabilized in 69.6% (16 of 23 patients) at the 6 week visit and persisted with longer follow-up. Four patients developed doubling of the visual angle. No patients developed rhegmatogenous retinal detachment, infection or neovascular glaucoma. One patient developed a small vitreous hemorrhage and 2 developed an increase in the size of pre-existing macular hemorrhage.
Conclusion: Intravitreal tPA administered early in the course of central retinal vein occlusion did not lead to catastrophic hemorrhagic events. Intravitreal tPA may cause worsening of vision in some patients. While some eyes appear to have benefited from the therapy, no conclusions can be reached because there was not a concurrent control group. A randomized clinical trial is necessary to determine its efficacy.
Summary statement: Intravitreal tPA administered early in the course of central retinal vein occlusion did not lead to catastrophic hemorrhagic events. A randomized clinical trial is necessary to determine its efficacy.