FIBRINOLYTIC THERAPY WITH LOW-DOSE RECOMBINANT TISSUE-PLASMINOGEN ACTIVATOR IN RETINAL VEIN OCCLUSION

Fibrinolytic therapy aimed at early restoration of blood flow appears to be a promising therapeutic approach in haemorrhagic retinopathy. Th e risk of bleeding complications, a major problem with fibrinolysis, c an be reduced by the use of low-dose thrombolytic regimens. In our stu dy, 14 patients with ischaemic central (CRVO) or branch (BRVO) retinal vein occlusion who presented with severe visual loss and recent onset of symptoms were treated with a low dose (50 mg) of recombinant tissu e plasminogen activator (rt-PA) and intravenous heparin. In 10 of 14 p atients (7 CRVO, 3 BRVO), an increase in visual acuity of one line or more on the logarithmic visual acuity chart was noted and in 8 patient s (6 CRVO, 2 BRVO) a reduction of areas of capillary non-perfusion was observed, suggesting that a restoration of retinal capillary blood fl ow can be achieved if fibrinolysis is initiated in the early phase of haemorrhagic retinopathy. In view of the poor prognosis in the natural course of haemorrhagic retinopathy and the potential haemorrhagic ris k in fibrinolysis, the use of low-dose rt-PA appears to constitute an encouraging approach in the management of this disease.