Thrombolytic therapy improves visual outcomes in CRVO patients

Retina. 2009;29(7):932-940.

Low-dose fibrinolytic therapy improves visual outcomes at 1 year compared with hemodilution but does not affect development of ocular neovascularization, according to a study.

In 20 patients with recent-onset central retinal vein occlusion treated by intravenous thrombolysis with low-dose recombinant tissue plasminogen activator, mean visual acuity at 1 year was 20/60 (range, 20/15 to light perception). In a control group of 21 CRVO patients treated with hemodilution therapy, median visual acuity was 20/400 (range, 20/20 to light perception).

More patients in the thrombolysis treatment group had improved visual acuity of three lines or more compared with hemodilution: 45% compared with 21%. However, at 1 year, neovascularization of the iris was observed in four patients in the thrombolysis group and three in the hemodilution group, and there was no difference in the percentage of patients requiring panretinal photocoagulation.

There were no significant differences between 11 branch retinal vein occlusion patients who were treated with thrombolysis or hemodilution.

There were no serious adverse events reported in the study. However, one patient in the thrombolysis group developed subretinal hemorrhage, most likely related to intravenous heparin therapy, and minor self-resolving hematomas developed in two patients in the thrombolysis group.