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Intravitreal Actilyse® injection to induce posterior vitreous detachment in eyes with recent onset of retinal vein occlusion

A retrospective evaluation

Intravitreale Actilyse®-Injektion zur Induktion einer hinteren Glaskörperabhebung in Augen mit kürzlich aufgetretenem retinalem Venenverschluss

Eine retrospektive Studie

  • Vitreoretinal Disorders and Vitrectomy
  • Published:
Spektrum der Augenheilkunde Aims and scope Submit manuscript

Summary

Purpose

To assess the efficacy of intravitreally injected tissue plasminogen activator (t-PA, Alteplase [Actilyse®]) to induce posterior vitreous detachment (PVD) in eyes with recent onset of retinal vein occlusion (RVO).

Methods

Retrospective patient chart analysis.

Results

Nine eyes were included thereof 4 eyes (44%) with central (CRVO) and 5 eyes (56%) with branch RVO (BRVO). One week after injection none of the eyes treated showed PVD formation. After 12 months one patient (17%) developed partial PVD and two patients (33%) demonstrated complete PVD. All eyes developing (partial) PVD after one year suffered from BRVO. Mean best corrected visual acuity (BCVA) increased from 0.35 to 0.45 after one week (p = 0.401) and further to 1.0 after 12 months (p = 0.042). There was an overall significant gain in mean BCVA development after 12 months (p = 0.015). Mean central retinal thickness decreased from 572 to 485 µm after one week (p = 0.374) and further to 299 µm after 12 months (p = 0.345). There was an overall significant decrease in CRT development from injection until month 12 (p = 0.030).

Conclusion

Intravitreally injected Actilyse® might have the potential to induce PVD in eyes with recent onset of RVO and might favorably impact standard treatment regimens. A prospective and randomized clinical trial is needed to prove this hypothesis.

Zusammenfassung

Zielsetzung

Ziel der Studie war es, die Wirksamkeit einer intravitrealen Injektion des Gewebeplasminogenaktivators (t-PA, Alteplase [Actilyse®]) bezüglich der Induktion einer hinteren Glaskörperabhebung (HGA) in Augen mit kürzlich aufgetretenem retinalem Venenverschluss (RVV) zu untersuchen.

Material und Methoden

Retrospektive Analyse von Patientenakten.

Ergebnisse

In die Studie wurden 9 Augen eingeschlossen, davon 4 (44%) mit Zentralvenenverschluss (ZVV) und 5 (56%) mit Venenastverschluss (VAV). Eine Woche nach Injektion war in keinem der behandelten Augen die Entwicklung einer HGA zu beobachten. Nach 12 Monaten fand sich bei einem Patienten (17%) eine partielle HGA, bei 2 Patienten (33%) eine komplette HGA. In allen Augen mit (partieller) HGA nach einem Jahr bestand ein VAV. Der Mittelwert der bestkorrigierten Sehschärfe stieg von 0,35 auf 0,45 nach einer Woche (p = 0,401) und weiter auf 1,0 nach 12 Monaten (p = 0,042). Es fand sich eine insgesamt signifikante Zunahme des Mittelwerts der bestkorrigierten Sehschärfe nach 12 Monaten (p = 0,015). Die mittlere zentrale Netzhautdicke sank von 572 auf 485 µm nach einer Woche (p = 0,374) und weiter auf 299 µm nach 12 Monaten (p = 0,345). Es fand sich eine insgesamt signifikante Abnahme der zentralen Netzhautdicke von der Injektion bis 12 Monate danach (p = 0,030).

Schlussfolgerung

Die intravitreale Injektion von Actilyse® könnte in Augen mit kürzlich aufgetretenem RVV eine HGA induzieren und die standardmäßigen Behandlungsregime günstig beeinflussen. Eine prospektive und randomisierte klinische Studie ist erforderlich, um diese Hypothese zu belegen.

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Authors and Affiliations

  1. Department of Ophthalmology, University Medical Center Goettingen, Robert-Koch-Straße 40, 37075, Goettingen, Germany

    Thomas Bertelmann

  2. Department of Ophthalmology, Philipps-University Marburg, Marburg, Germany

    Stefan Strodthoff & Walter Sekundo

  3. Department of Ophthalmology, Feldkirch State Hospital, Feldkirch, Austria

    Stefan Mennel

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  1. Thomas Bertelmann
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  2. Stefan Strodthoff
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  4. Stefan Mennel
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Correspondence to Thomas Bertelmann.

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Conflict of interest

T. Bertelmann, S. Strodthoff, W. Sekundo and S. Mennel declare that they have no competing interests.

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Bertelmann, T., Strodthoff, S., Sekundo, W. et al. Intravitreal Actilyse® injection to induce posterior vitreous detachment in eyes with recent onset of retinal vein occlusion. Spektrum Augenheilkd. 32, 39–45 (2018). https://doi.org/10.1007/s00717-017-0351-z

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