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Abstract
Purpose
To evaluate the efficacy of intravitreal tissue plasminogen activator (tPA) with C3 F8 injection for branch retinal vein occlusion (BRVO) involving fovea.
Methods
Seven patients (7 eyes) presenting with subfoveal hemorrhage caused by BRVO were treated with an intravitreal tPA and C3 F8 injection. We assessed the visual acuity (VA) and foveal thickness measured with optical coherence tomography.
Results
The mean duration of symptoms before surgery was 5.42±1.90 weeks. The mean logMAR VA improved from 1.14±0.19 at baseline to 0.87±0.34 at one week and 0.30±0.32 at six months. The mean foveal thickness decreased from 564.421±186.88 µm at baseline to 483.14±275.06 μ m at one week and 353.28±152.99 μ m at six months. There was no adverse effect related to the treatment.
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References
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 | Figure 1.The left eye of a 66-year-old woman (patient 4) was treated with an intravitreal tPA and C3 F8 injection after 4 weeks of visual symptom. (A) Pretreatment fundus photograph. The fovea was affected by edema and hemorrhage. Visual acuity was 0.06. (B) Pretreatment OCT showed macular edema with foveal thickness of 372 µm. (C) Fundus photograph of 1 month after treatment. Visual acuity improved to 0.2. (D) OCT of 1 month after treatment shows decreased macular edema. Foveal thickness was 316 µm. (E) Fundus photograph of 6 months after treatment showed that the intraretinal hemorrhage was almost absorbed and the macular edema resolved. visual acuity improved to 0.3. (F) OCT showed that retinal thickness is markedly reduced with foveal thickness of 214 µm. |
 | Figure 2.The left eye of a 56-year-old man (patient 2) with sudden decrease in vision of 7 days duration. (A) Initial fundus photograph with superotemporal branch vein occlusion. Visual acuity was 0.15. (B) Pretreatment fundus photograph with increasing intraretinal hemorrhage. visual acuity was 0.15. (C) Fundus photograph 1 day after intravitreal tPA and C3 F8 injection. macular hemorrhage was displaced. (D) Fundus photograph 6 months after treatment. The macular area was still affected by remaining retinal hemorrhage. Visual acuity was 0.1. (E) Pretreatment OCT showed cystic space at the fovea and the sensory retina is thickened with foveal thickness of 422 µm. (F) OCT 6 months after treatment showed stationary macular edema. Foveal thickness was 443 µm. |
Table 1.
Clinical characteristics of patients
| Patient | Age (yrs) | Sex | Eye | HTN* | Duration of symptom (days) | Duration of symptom To treatment (weeks) | Involved branch | F/U Period (months) |
|---|---|---|---|---|---|---|---|---|
| 1 | 36 | M | R | + | 5 | 4 | IT† | 6 |
| 2 | 56 | M | L | + | 7 | 4 | ST‡ | 8 |
| 3 | 44 | F | R | + | 10 | 4 | IT | 8 |
| 4 | 66 | F | L | + | 14 | 4 | IT | 7 |
| 5 | 43 | M | R | − | 7 | 6 | ST | 8 |
| 6 | 73 | F | L | + | 7 | 8 | IT | 7 |
| 7 | 63 | F | R | − | 14 | 8 | ST | 6 |
Table 2.
Distribution of visual acuity and foveal thickness
| Patient |
Initial VA* |
Pre treatment VA |
Post-treatment VA |
Pre treatment FT† |
Post-treatment FT | ||||||
|---|---|---|---|---|---|---|---|---|---|---|---|
| 1W | 1M | 3M | 6M | 1W | 1M | 3M | 6M | ||||
| 1 | 1.0 | 0.05 | 0.4 | 0.2 | 0.5 | 0.2 | 761 | 346 | 499 | 309 | 226 |
| 2 | 0.15 | 0.15 | 0.2 | 0.15 | 0.1 | 0.1 | 422 | 330 | 468 | 443 | 443 |
| 3 | 0.1 | 0.05 | 0.05 | 0.1 | 0.1 | 0.3 | 450 | 311 | 335 | 275 | 212 |
| 4 | 0.2 | 0.06 | 0.2 | 0.2 | 0.3 | 0.3 | 372 | 287 | 316 | 220 | 214 |
| 5 | 0.7 | 0.05 | 0.05 | 0.1 | 0.1 | 0.1 | 713 | 510 | 499 | 375 | 344 |
| 6 | 0.3 | 0.08 | 0.2 | 0.1 | 0.1 | 0.1 | 421 | 287 | 458 | 416 | 180 |
| 7 | 0.2 | 0.1 | 0.1 | 0.1 | 0.1 | 0.1 | 805 | 567 | 503 | 493 | 554 |
Table 3.
Outcome of visual acuity and foveal thickness
| Pretreatment | 1 Week | 1 Month | 3 Months | 6 Months | |
|---|---|---|---|---|---|
| Visual acuity (LogMAR) | 1.14±0.19 | 0.87±0.34 | 0.88±0.15 | 0.82±0.29 | 0.3±0.32 |
| P-value* | 0.000 | 0.001 | 0.001 | 0.000 | |
| Foveal thickness (µm) | 564.42±186.88 | 483.14±275.06 | 439.72±80.04 | 361.57±97.76 | 353.28±152.99 |
| P-value | 0.001 | 0.004 | 0.001 | 0.001 | |
| Improvement (2 or more line) | 3/7 (42.9%) | 2/7 (28.6%) | 2/7 (28.6%) | 3/7 (42.9%) |
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