Visual Outcome after Treatment with Low-Dose Recombinant Tissue Plasminogen Activator or Hemodilution in Ischemic Central Retinal Vein Occlusion

Abstract

The ischemic type of central retinal vein occlusion (CRVO) is associated with a poor visual and ocular prognosis. Although several reports have indicated that hemodilution or thrombolytic therapy may be of benefit, there is still no consensus among ophthalmologists about the management of this disorder. In our study, we retrospectively evaluated the visual outcome after medical treatment in 58 patients with ischemic CRVO and severe visual loss (≤20/50). We separately investigated three different groups, depending on the following criteria: onset of symptoms within 11 days prior to admission and thrombolytic treatment with 50 mg of recombinant tissue plasminogen activator (rtPA) and intravenous heparinization (n = 23) or hemodilution therapy (n = 22) or onset of symptoms >11 days before the initial visit and hemodilution (n = 13). An advancement of 2 or more lines on the logarithmic visual acuity chart was noted in 10 cases (44%) in the rtPA group and in 3 subjects (14%) in the early-phase hemodilution group, whereas only 1 patient in the late-phase hemodilution group showed a comparable improvement. Our findings suggest that treatment with low-dose rtPA or hemodilution aimed at early restoration of blood flow has the potential to improve the visual prognosis in ischemic CRVO. The finding that thrombolysis had a favorable outcome supports the hypothesis that specific subgroups of patients may benefit from this therapeutic approach. Further investigation will be required to definitively prove the effectiveness of fibrinolytic agents.

Selective Thrombophilia Screening in Young Patients with Retinal Artery Occlusion

“…Most of these studies did not take into account the presence of cardiovascular risk factors or patient age by the time of the RAO. However, previous investigations on the role of thrombophilia in retinal vascular occlusive diseases had indicated that thrombophilia screening in affected individuals should be selective [14,15,16,17,28,29,30,31,32,33,34]. In the present study, we investigated a highly preselected subgroup of younger patients with RAO who had undergone a comprehensive routine screening for thrombophilic disorders that have been associated with arterial occlusive diseases, including protein C and protein S, antithrombin III, resistance to APC, factor II gene polymorphisms, anticardiolipin antibodies, factor VIII:C, PAI-1 activity, homocysteine and Lp(a) levels, and factor XII.…”

Management of Retinal Vein Occlusion – Consensus Document

“…Hemodilution is expected to prevent the slowdown of blood circulation and its complications by dramatically lowering blood viscosity. Some randomized studies have been published on the topic and concluded on a statistically significant difference between treated and nontreated patients [61,79,80,81,82]. Nevertheless, these monocenter studies were conducted in the 1980s and 1990s, and they used different treatment protocols.…”

Retinal Venous Occlusions: Diagnosis and Choice of Treatments

“…Recombinant tissue plasminogen activator (rtPA) is a synthetic fibrinolytic agent that converts plasminogen to plasmin and destabilizes intravascular thrombi. rtPA, as therapy against CRVO, has been administered by several routes: systemic [13,14], intravitreal [15,16,17], and by endovascular cannulation of retinal vessels either through a neuroradiological or a vitreoretinal approach, and delivery of minute quantities of rtPA directly to the occluded vessels to release the suspected thrombus [18,20,21]. …”