Updated cannulation technique for tissue plasminogen activator injection into peripapillary retinal vein for central retinal vein occlusion

Abstract

ABSTRACT.Purpose: To update the surgical technique in which a vitrectomy is performed and a retinal branch vein is cannulated and infused with recombinant tissue plasminogen activator (RTPA) to treat central retinal vein occlusion (CRVO) in patients who present with very low visual acuity (VA). Methods: Twelve consecutive patients (12 eyes) with CRVO and low VA (logMAR >1.00) at presentation were treated using this method. Results: Cannulation of a peripapillary retinal vein and stable injection of RTPA was successfully performed without surgery-related complications in all 12 eyes. At 12 months after surgery, 8 of the 12 patients (67%) experienced at least one line of improvement in best corrected visual acuity; 6 of the 12 (50%) improved ≥5 lines and 2 (17%) improved ≥8 lines. After additional grid laser and/or subconjunctival or intravitreal corticosteroids, the mean decrease in central foveal thickness was 260 lm, and the mean total macular volume decreased from 12.10 mm 3 to 9.24 mm 3 . Four patients received panretinal photocoagulation to treat either iris neovascularization (n = 2) or neovascularization of the retina and/or disc (n = 2). Conclusion: Administration of RTPA via a peripapillary vein using this updated technique provides an alternative or additional treatment option for patients with very low VA after CRVO.

Robot‐assisted retinal vein cannulation in an in vivo porcine retinal vein occlusion model

“…This was found beneficial as it allows compensating for physiologic cardiovascular-and respiratory-induced movements of the retinal structures without breaking nor occluding. The puncturing method described by van Overdam et al (2015) with an approach reaching over the optic disc to the contralateral hemivein was not tested in this trial because of the large variation of retinal venous anatomy in the porcine eyes. Furthermore, the cannulations performed at the optic disc border were all successful and very well controlled with a clear direct view on the needle tip, targeted vessel and intraluminal tip advancement.…”

“…Others managed to maintain infusion for about 1.5 min (van Overdam et al. ) but did not find a significant increase in visual function.…”

“…Using rtPA, most researchers report to succeed in a local intravenous retinal bolus injection (Weiss & Bynoe 2001;Bynoe et al 2005;Yamamoto et al 2009;Kadonosono et al 2013). Others managed to maintain infusion for about 1.5 min (van Overdam et al 2015) but did not find a significant increase in visual function.…”

Feasibility study on robot‐assisted retinal vascular bypass surgery in an ex vivo porcine model

“…Retinal vascular surgery, including sheathotomy (Yamane et al 2014), endovascular injection (Kadonosono et al 2011;Pournaras et al 2012;van Overdam et al 2015) and vascular bypass (Shen et al 2009(Shen et al , 2016Chen et al 2011), is emerging as an exciting area of microsurgical intervention that attempts to re-establish retinal venous outflow. Additional clinical trials will likely substantiate the utility of these approaches.…”

Fibrinolytic and Surgical Treatment Approaches for Retinal Vein Occlusion

“…It was suggested that these disappointing results were due to a long interval before intervention and inexperience of the surgeons. Considering the results of these previous reports, a recent study showed that three main factors appear to be important to affect results: first is the time between intervention with RVO; second is experience of the surgeon and third is RVO subtype, ischemic or non-ischemic [24] . In summary, direct administration of t-PA via retinal vein cannulation during vitreoretinal surgery is a feasible technique and has been shown to be effective in patients with CRVO; but currently there are no studies on its effectiveness in BRVO.…”