Thrombolytic therapy for central retinal vein occlusion: results of a pilot study

• Published in: Transactions of the American Ophthalmological Society Vol. 94; pp. 471 - 504
• Main Author: Elman, M J
• Format: Journal Article
• Language: English
• Published: United States 1996
• Subjects: Adult; Aged; Feasibility Studies; Female; Fluorescein Angiography; Fundus Oculi; Humans; Male; Middle Aged; Pilot Projects; Plasminogen Activators - adverse effects; Plasminogen Activators - therapeutic use; Retinal Vein - pathology; Retinal Vein - physiopathology; Retinal Vein Occlusion - drug therapy; Retinal Vein Occlusion - pathology; Retinal Vein Occlusion - physiopathology; Thrombolytic Therapy; Tissue Plasminogen Activator - adverse effects; Tissue Plasminogen Activator - therapeutic use; Treatment Outcome; Visual Acuity - physiology
• ISSN: 0065-9533; 1545-6110

To evaluate the feasibility of conducting a randomized, controlled trial of thrombolytic therapy for central retinal vein occlusion (CRVO) using tissue plasminogen activator (TPA); to establish relative efficacy and safety of various dosing regimens. Ninety-six patients with CRVO were treated with TPA between May 1986 and December 1992. Prior to patient enrollment, a standardized, detailed protocol was developed for evaluation and treatment of all patients. This included standard protocols for determining eligibility, reporting complications, performing photography and electroretinography, and measuring visual acuity. Best corrected visual acuity at 6 months, systemic and ophthalmic treatment complications. At 6 months' follow-up, 42% (n = 89) of eyes gained three or more lines of vision from pretreatment levels (average gain, 5.1 lines), 37% remained stable, and 21% lost three or more lines. Of eyes with 20/100 or worse pretreatment vision (n = 32), 59% gained three or more lines vision (average gain, 6.4 lines), 31% remained stable, and 9% lost three or more lines. One patient suffered a fatal stroke. Three patients developed intraocular bleeding during TPA administration. Thromobolytic therapy with TPA appears to be a promising, albeit risky, new treatment; conclusive evaluation of safety and efficacy awaits a multicenter, randomized, clinical trial; feasibility of such a trial has been established by this study.