Abstract
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 =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.
Highlights
Retinal venous occlusion is the second vascular disorder of the retina after diabetic retinopathy and despite advances in many aspect of ophthalmology this disorder still causes visual loss frequently
Panretinal photocoagulation has been effective in decreasing the rate of progression to neovascular glaucoma (NVG), but it has not been proved to have a prophilytic effect for development of INV itself [2,3,4] so occurrence of INV still remains a principal pitfall in the management of Ischemic Complications in Retinal Vein Occlusion (CRVO)
This study aims to evaluate effect of intravitreal tissue Plasminogen activator in improvement of visual acuity in Branch Retinal Vein Occlusion (BRVO) and ischemic CRVO, and rate of occurrence of complications such as retinal detachment, vitreous hemorrhage, endophthalmitis, NVI, NVE, NVG and NVD
Summary
Retinal venous occlusion is the second vascular disorder of the retina after diabetic retinopathy and despite advances in many aspect of ophthalmology this disorder still causes visual loss frequently. The two most common leading causes of visual loss in CRVO are: macular involvement by whether ischemia or edema and neovascular glaucoma secondary to Iris neovascualarization (the latter seen mostly in ischemic CRVO). Both types of RVO are commonly associated with underlying disorders such as Diabetes Mellitus, Hypertension and previous history of coronary artery disease. Panretinal photocoagulation has been effective in decreasing the rate of progression to neovascular glaucoma (NVG), but it has not been proved to have a prophilytic effect for development of INV itself [2,3,4] so occurrence of INV still remains a principal pitfall in the management of Ischemic CRVO. Crid pattern laser photocoagulation has been shown to be effective in resolving macular edema angiographicallybut no significant change has occurred in visual acuity
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