Treatment of central retinal vein occlusion by vitrectomy with lysis of vitreopapillary and epipapillary adhesions, subretinal peripapillary tissue plasminogen activator injection, and photocoagulation.
OBJECTIVE
To report a case of subretinal peripapillary tissue plasminogen activator (tPA) injection with vitreopapillary and epipapillary membrane dissection and peripheral photocoagulation in the treatment of central retinal vein occlusion.


METHODS
Interventional case report.


METHODS
A 79-year-old woman with a history of branch vein occlusion in the left eye presented with visual loss in the right eye for 4 months secondary to unresolved central retinal vein occlusion. She underwent vitrectomy, right eye, with lysis of vitreopapillary and epipapillary adhesions and hyaloid separation, subretinal peripapillary tissue tPA injection, peripheral photocoagulation, and air-fluid exchange.


RESULTS
Postoperatively, funduscopic and fluorescein angiographic features of venous obstruction improved rapidly, with prompt reduction in intraretinal hemorrhages and disk and macular edema. The patient reported subjective improvement of vision in her right eye, although measured improvement was modest, from finger counting to 20/400.


CONCLUSIONS
Subretinal administration of tPA, lysis of adhesions, and endophotocoagulation may be of value in resolving the obstructive component of selected cases of chronic central retinal vein occlusion associated with vitreopapillary and epipapillary traction.
Lam
HarHiu D
HD
Department of Ophthalmology, Stanford University Medical Center, California 94305, USA.
Blumenkranz
Mark S
MS
D000368:Aged; D005128:Eye Diseases / Q000628:therapy*; D005260:Female; D005654:Fundus Oculi; D006801:Humans; D008028:Light Coagulation; D009898:Optic Disk; D012160:Retina; D012169:Retinal Vein / Q000473:pathology; D012170:Retinal Vein Occlusion / Q000473:pathology / Q000601:surgery*; D000267:Tissue Adhesions / Q000628:therapy; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage* / Q000627:therapeutic use; D014821:Vitrectomy; D014822:Vitreous Body
D010959:Tissue Plasminogen Activator