S 490
New approaches to the assessment of thrombolysis in retinal vessel occlusion
L.-O. Hattenbach, H. Gümbel, F. Koch, C. Ohrloff
During the past decades, numerous case reports or pilot studies have indicated that thrombolysis may have a beneficial effect in the management of retinal vessel occlusion. However, thus far, no study exists which definitively could prove the effectiveness of thrombolytic therapy in retinal artery or retinal vein occlusion.
Although it may be speculated that the use of fibrinolytic agents such as urokinase, streptokinase or recombinant tissue plasminogen activator (rt-PA) constitutes a reasonable therapeutic approach in retinal vessel occlusion, it is of some concern that, in a non-life threatening situation, the systemic administration of these agents carries a risk of hemorrhage. Thus, the use of an appropriate intravenous thrombolytic therapy remains a matter of controversy within the ophthalmologic community.
The current therapeutic dilemma necessitates further investigations to provide stronger evidence in support of a guideline for the use of fibrinolytic agents in retinal vessel occlusion. With regard to a maximum safety and effectiveness, there is a need to identify indication criteria and optimal treatment strategies.
Here we report on an ongoing prospective randomized multicenter trial of hemodilution or thrombolysis with low-dose rt-PA in ischemic retinal vein occlusion. Based on experiences from this study and a comparison of available data, we present a concept for future controlled trials which may help to determine the benefit of thrombolysis in the management of retinal vessel occlusion.
Klinik für Augenheilkunde, Klinikum der Johann-Wolfgang-Goethe-Universität, D-60590 Frankfurt am Main