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Thrombolysis in retinal vessel occlusion: a current analysisL.-O. Hattenbach, H. Gümbel, F. Koch, C. Ohrloff
In the management of acute major vessel occlusion, the use of fibrinolytic agents such as recombinant tissue plasminogen activator (rt-PA), urokinase or streptokinase is widely accepted. In view of the histopathological and clinical features of retinal vessel occlusion, fibrinolysis aimed at early restoration of blood flow may constitute a reasonable treatment option. However, because the systemic administration of fibrinolytic agents is associated with a hemorrhagic risk, there is still no consensus among ophthalmologists about this therapeutic approach.
Several studies of fibrinolytic therapy in patients with retinal vessel occlusion are reviewed to determine whether this treatment is likely to improve major clinical outcomes. In addition, we report on our results of fibrinolytic therapy with low dose rt-PA in patients with retinal vessel occlusion. Moreover, we review the large scale trials of fibrinolysis in myocardial infarction and acute ischemic stroke to evaluate safety and efficacy of various thrombolytic regimens.
The current data suggest that thrombolysis may be of value in the management of retinal vessel occlusion. The choice of an appropriate intravenous thrombolytic therapy should be based on minimizing the risk of adverse events.
Klinik für Augenheilkunde, Klinikum der Johann Wolfgang Goethe Universität, D-60590 Frankfurt am Main