title: Combination therapy with intravitreal tissue plasminogen activator and ranibizumab for subfoveal type 2 choroidal neovascularization.
abstract: OBJECTIVE
  Fibrovascular scar formation related to subfoveal type 2 choroidal neovascularization (CNV) often causes severe vision loss in eyes with age-related macular degeneration. The authors assessed additional impacts of intravitreal tissue plasminogen activator (tPA), a fibrinolytic compound, combined with intravitreal ranibizumab (IVR) on subfoveal type 2 CNV.
  
  
  METHODS
  Eight eyes of eight patients with type 2 CNV underwent intravitreal injections of ranibizumab and tPA (IVR/tPA) (40 kIU). Twelve eyes of 12 patients with type 2 CNV were treated with only IVR injections, as the control group. For retreatment, IVR was performed as needed. The best-corrected visual acuity (BCVA) and the central retinal thickness (CRT) and macular volume (MV) on optical coherence tomography were recorded periodically for 6 months.
  
  
  RESULTS
  The subretinal fibrinous and fibrovascular tissue complex regressed or contracted immediately after administration of IVR/tPA in contrast to IVR monotherapy. The total numbers of IVR injections did not differ significantly between the two groups. The mean logarithm of the minimum angle of resolution BCVA in the combination therapy group improved significantly from 0.72 at baseline to 0.51 at month 6 and was superior to that in the monotherapy group (0.70-0.79). The improvements of the mean CRT and MV in the combination therapy group were superior to the monotherapy group. No tPA-related complications developed.
  
  
  CONCLUSIONS
  tPA may have a specific ability to regress already formed subretinal fibrinous and fibrovascular tissue complexes in eyes with type 2 CNV, potentially increasing the chances of visual improvement through a synergistic relationship with anti-VEGF therapies.
authors.affiliation: Department of Ophthalmology and Visual Science, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi, 467-8601, Japan.
authors.forename: Ikuko
authors.initials: I
authors.lastname: Kachi
authors.affiliation: Department of Ophthalmology and Visual Science, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi, 467-8601, Japan. yasukawa@med.nagoya-cu.ac.jp.
authors.forename: Tsutomu
authors.initials: T
authors.lastname: Yasukawa
authors.affiliation: Department of Ophthalmology and Visual Science, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi, 467-8601, Japan.
authors.forename: Aki
authors.initials: A
authors.lastname: Kato
authors.affiliation: Department of Ophthalmology and Visual Science, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi, 467-8601, Japan.
authors.forename: Noriaki
authors.initials: N
authors.lastname: Takase
authors.affiliation: Department of Ophthalmology and Visual Science, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi, 467-8601, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Morita
authors.affiliation: Department of Ophthalmology and Visual Science, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi, 467-8601, Japan.
authors.forename: Ayae
authors.initials: A
authors.lastname: Kubota
authors.affiliation: Department of Ophthalmology and Visual Science, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi, 467-8601, Japan.
authors.forename: Yoshio
authors.initials: Y
authors.lastname: Hirano
authors.affiliation: Department of Ophthalmology and Visual Science, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi, 467-8601, Japan.
authors.forename: Akiyoshi
authors.initials: A
authors.lastname: Uemura
authors.affiliation: Department of Ophthalmology and Visual Science, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi, 467-8601, Japan.
authors.forename: Yuichiro
authors.initials: Y
authors.lastname: Ogura
mesh_terms: D000368:Aged; D020533:Angiogenesis Inhibitors / Q000008:administration & dosage; D020256:Choroidal Neovascularization / Q000175:diagnosis / Q000188:drug therapy*; D004359:Drug Therapy, Combination; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage; D005584:Fovea Centralis / Q000000981:diagnostic imaging*; D006801:Humans; D058449:Intravitreal Injections; D008297:Male; D000069579:Ranibizumab / Q000008:administration & dosage*; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage*; D041623:Tomography, Optical Coherence; D014792:Visual Acuity
chemical_list: D020533:Angiogenesis Inhibitors; D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator; D000069579:Ranibizumab
keywords: Age-related macular degeneration; Intravitreal ranibizumab; Tissue plasminogen activator; Type 2 choroidal neovascularization