Intravitreal Tissue Plasminogen Activator in the Management of Central Retinal Vein Occlusion

Purpose To evaluate the role of intravitreal tissue plasminogen activator (tPA) in the management of central retinal vein occlusion (CRVO) in patients with symptoms for <3 days. Methods We evaluated the visual outcome of a consecutive series of patients with CRVO following intravitreal tPA injection. All patients presented with visual acuity worse than 20/50 within 3 days from the onset of symptoms. Main outcome measures included percentage of patients whose final vision improved to 20/50 or better and change in percentage of patients with vision of 20/200 or worse before and after treatment. Results Twelve patients received intravitreal tPA for CRVO. Nine patients (75%) had best-corrected visual acuity of 20/200 or worse at presentation compared with 4 patients (33%) at the last follow-up after treatment. Five (55%) of these 9 patients had final visual acuity that improved to 20/50 or better. The remaining four patients did not have improvement or their vision continued to worsen. All 4 patients had fluorescein angiographic evidence of >10 disk areas of capillary nonperfusion at presentation. Overall, 8 (67%) of 12 patients had final visual acuity of 20/50 or better. No side effects related to tPA injection were observed. Conclusion Our data suggest that intravitreal tPA injection may have a beneficial role in the management of CRVO when used within a few days of the onset of symptoms in patients with no angiographic evidence of severe capillary nonperfusion even if initial visual acuity is 20/200 or worse.