Retinal toxicity of intravitreal tissue plasminogen activator: case report and literature review

Ophthalmology. 2003 Apr;110(4):704-8. doi: 10.1016/S0161-6420(02)01979-6.


Objective: To present the clinical picture of retinal toxicity of commercial tissue plasminogen activator (tPA).

Design: Case report and literature review.

Methods: Two successive intravitreal injections of tPA (50 micro g) 3 days apart with gas tamponade were given to treat a 49-year-old man with submacular hemorrhage. The adverse consequences of this treatment were monitored. A literature review of retinal toxicity of commercial tPA in animals was also done.

Main outcome measures: Retinal findings, electroretinograph (ERG) and visual acuity testing.

Results: Diffuse pigmentary alterations sparing the posterior pole, poor visual acuity after the absorption of submacular hemorrhage, reduced scotopic and photopic ERG A- and B-waves were noted.

Conclusions: This is the first reported case of retinal toxicity of commercial tPA in humans that resembles the descriptions of tPA-mediated retinal toxicity in animal models. The dosage of intravitreal tPA (between 50 and 100 micro g) may be toxic to the human retina.

Publication types

  • Case Reports
  • Review

MeSH terms

  • Electroretinography / drug effects
  • Fluorescein Angiography
  • Humans
  • Injections
  • Male
  • Middle Aged
  • Ophthalmic Solutions
  • Pigment Epithelium of Eye / drug effects*
  • Pigment Epithelium of Eye / pathology
  • Plasminogen Activators / adverse effects*
  • Retinal Diseases / chemically induced*
  • Retinal Diseases / diagnosis
  • Retinal Hemorrhage / drug therapy
  • Tissue Plasminogen Activator / adverse effects*
  • Visual Acuity / drug effects
  • Vitreous Body


  • Ophthalmic Solutions
  • Plasminogen Activators
  • Tissue Plasminogen Activator