J Korean Ophthalmol Soc > Volume 50(5); 2009 > Article
Journal of the Korean Ophthalmological Society 2009;50(5):800-803.
DOI: https://doi.org/10.3341/jkos.2009.50.5.800    Published online May 15, 2009.
Retinal Toxicity of Intravitreal Tissue Plasminogen Activator on Submacular Hemorrhage.
Jong Jin Jung, Sung Won Cho
Myung-Gok Eye Research Institute, Department of Ophthalmology, Kim's Eye Hospital, Konyang University, Seoul, Korea. eyecure@kimeye.com
황반하출혈 환자에서 조직형 플라스미노겐 활성제(tPA) 주입술 후 발생한 망막독성 1예
정종진ㆍ조성원
Myung-Gok Eye Research Institute, Department of Ophthalmology, Kim’s Eye Hospital, Konyang University, Seoul, Korea
Abstract
PURPOSE
To present the clinical feature of retinal toxicity of intravitreal tissue plasminogen activator which was used for treatment of submacular hemorrhage. CASE SUMMARY: An intravitreal injection of tPA (100 microg) with C3F8 gas tamponade (0.2 cc) was given to treat the submacular hemorrhage in a patient with ARMD. The therapeutic effect was measured by visual acuity, slit lamp examination, indirect funduscopy and fluorescein angiogram. Three months after the operation, the hemorrhage was decreased but a pigmentary change was observed on the peripheral retina. After 8 months, the submacular hemorrhage completely reabsorbed but the peripheral pigmentary change had increased. Ten months later, the retinal pigmentary change was observed on the entire retina except the posterior pole. The fluorescein angiogram showed peripheral hyperfluorescene of the retina due to window defect from the pigmentary change but no leakage was detected. The electroretinogram showed reduced amplitude in the right eye. CONCLUSIONS: Intravitreal tPA injection of 25 to 100 microg with pneumatic displacement is typically used for the treatment of submacular hemorrhage. However, there is no established safety dose of tPA for use in human eyes. In the present study, 100 microg of tPA was used and retinal toxicity was noted. Establishing a safety dose of tPA to prevent dosage dependent complications is necessary.
Key Words: ARMD;Retinal toxicity;Submacular hemorrhage;tPA


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