title: Updated cannulation technique for tissue plasminogen activator injection into peripapillary retinal vein for central retinal vein occlusion.
abstract: OBJECTIVE
  To update the surgical technique in which a vitrectomy is performed and a retinal branch vein is cannulated and infused with recombinant tissue plasminogen activator (RTPA) to treat central retinal vein occlusion (CRVO) in patients who present with very low visual acuity (VA).
  
  
  METHODS
  Twelve consecutive patients (12 eyes) with CRVO and low VA (logMAR >1.00) at presentation were treated using this method.
  
  
  RESULTS
  Cannulation of a peripapillary retinal vein and stable injection of RTPA was successfully performed without surgery-related complications in all 12 eyes. At 12 months after surgery, 8 of the 12 patients (67%) experienced at least one line of improvement in best corrected visual acuity; 6 of the 12 (50%) improved ≥5 lines and 2 (17%) improved ≥8 lines. After additional grid laser and/or subconjunctival or intravitreal corticosteroids, the mean decrease in central foveal thickness was 260 μm, and the mean total macular volume decreased from 12.10 mm(3) to 9.24 mm(3) . Four patients received panretinal photocoagulation to treat either iris neovascularization (n = 2) or neovascularization of the retina and/or disc (n = 2).
  
  
  CONCLUSIONS
  Administration of RTPA via a peripapillary vein using this updated technique provides an alternative or additional treatment option for patients with very low VA after CRVO.
authors: The Rotterdam Eye Hospital, Rotterdam, the Netherlands.|The Rotterdam Ophthalmic Institute, Rotterdam, the Netherlands.
authors: Koen A
authors: KA
authors: van Overdam
authors: The Rotterdam Eye Hospital, Rotterdam, the Netherlands.
authors: Tom
authors: T
authors: Missotten
authors: The Rotterdam Eye Hospital, Rotterdam, the Netherlands.
authors: Leigh H
authors: LH
authors: Spielberg
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002404:Catheterization / Q000379:methods*; D003131:Combined Modality Therapy; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage*; D005451:Fluorescein Angiography; D006801:Humans; D007262:Infusions, Intravenous; D017075:Laser Coagulation; D008297:Male; D008875:Middle Aged; D010781:Photography; D011446:Prospective Studies; D012169:Retinal Vein / Q000187:drug effects*; D012170:Retinal Vein Occlusion / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage*; D041623:Tomography, Optical Coherence; D014792:Visual Acuity / Q000502:physiology; D014821:Vitrectomy
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator
keywords: cannulation; central retinal vein occlusion; recombinant tissue plasminogen activator; surgical treatment; vitrectomy