Although central retinal vein occlusion and branch retinal vein occlusion are among the most common vascular disorders affecting the retina, there is a great deal of confusion about their management. In view of the histopathological features of ischemic retinal vein occlusions, the use of fibrinolytic agents such as rt-PA (recombinant tissue-plasminogen activator) appears to be the most promising therapeutic approach.
Patients: In nine patients with ischemic retinal vein occlusion, 50 mg of rt-PA were given i.v. over a period of 60 min. Simultaneously, heparin was infused at 1200 U/h. The i.v. heparinization was continued over a period of 8 days.
Results: The clinical course was assessed by documenting visual acuity, fluorescein angiographies and fundal examinations. Additionally, several coagulation parameters were measured. No hemorrhagic complications were observed. In 8 cases, an improvement of visual acuity and retinal perfusion was noted.
Conclusion: Based on our results, we would recommend the fibrinolytic therapy with rt-PA and heparin in the treatment of ischemic retinal vein occlusions.