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Retinal toxicity of intravitreal tissue plasminogen activator: case report and literature review
San-Ni Chen1, Te-Cheng Yang, Cheng-Lien Ho
1Department of Ophthalmology, Chang-Gung Memorial Hospital, Linkou, Taiwan, R.O.C.
Objective:
To present the clinical picture of retinal toxicity of commercial tissue plasminogen activator (tPA).
Design:
Case report and literature review.
Methods:
Two successive intravitreal injections of tPA (50 micro g) 3 days apart with gas tamponade were given to treat a 49-year-old man with submacular hemorrhage. The adverse consequences of this treatment were monitored. A literature review of retinal toxicity of commercial tPA in animals was also done.
Main Outcome Measures:
Retinal findings, electroretinograph (ERG) and visual acuity testing.
Results:
Diffuse pigmentary alterations sparing the posterior pole, poor visual acuity after the absorption of submacular hemorrhage, reduced scotopic and photopic ERG A- and B-waves were noted.
Conclusions:
This is the first reported case of retinal toxicity of commercial tPA in humans that resembles the descriptions of tPA-mediated retinal toxicity in animal models. The dosage of intravitreal tPA (between 50 and 100 micro g) may be toxic to the human retina.
