Retinal toxicity of intravitreal tissue plasminogen activator: case report and literature review.
OBJECTIVE
To present the clinical picture of retinal toxicity of commercial tissue plasminogen activator (tPA).


METHODS
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.


METHODS
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.
Chen
San-Ni
SN
Department of Ophthalmology, Chang-Gung Memorial Hospital, Linkou, Taiwan, R.O.C.
Yang
Te-Cheng
TC
Ho
Cheng-Lien
CL
Kuo
Ya-Hui
YH
Yip
Yeung
Y
Chao
An-Ning
AN
D004596:Electroretinography / Q000187:drug effects; D005451:Fluorescein Angiography; D006801:Humans; D007267:Injections; D008297:Male; D008875:Middle Aged; D009883:Ophthalmic Solutions; D010857:Pigment Epithelium of Eye / Q000187:drug effects* / Q000473:pathology; D010960:Plasminogen Activators / Q000009:adverse effects*; D012164:Retinal Diseases / Q000139:chemically induced* / Q000175:diagnosis; D012166:Retinal Hemorrhage / Q000188:drug therapy; D010959:Tissue Plasminogen Activator / Q000009:adverse effects*; D014792:Visual Acuity / Q000187:drug effects; D014822:Vitreous Body
D009883:Ophthalmic Solutions; D010960:Plasminogen Activators; D010959:Tissue Plasminogen Activator