Visual outcome after treatment with low-dose recombinant tissue plasminogen activator or hemodilution in ischemic central retinal vein occlusion

The ischemic type of central retinal vein occlusion (CRVO) is associated wi th a poor visual and ocular prognosis, Although several reports have indica ted that hemodilution or thrombolytic therapy may be of benefit, there is s till no consensus among ophthalmologists about the management of this disor der. In our study, we retrospectively evaluated the visual outcome after me dical treatment in 58 patients with ischemic CRVO and severe visual loss (l ess than or equal to 20/50). We separately investigated three different gro ups, depending on the following criteria: onset of symptoms within 11 days prior to admission and thrombolytic treatment with 50 mg of recombinant tis sue plasminogen activator (rtPA) and intravenous heparinization (n = 23) or hemodilution therapy (n = 22) or onset of symptoms >11 days before the ini tial 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, where as only 1 patient in the late-phase hemodilution group showed a comparable improvement. Our findings suggest that treatment with low-dose rtPA or hemo dilution aimed at early restoration of blood flow has the potential to impr ove the visual prognosis in ischemic CRVO. The finding that thrombolysis ha d a favorable outcome supports the hypothesis that specific subgroups of pa tients may benefit from this therapeutic approach. Further investigation wi ll be required to definitively prove the effectiveness of fibrinolytic agen ts. Copyright (C) 1999 S. Karger AG, Basel.