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.
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.
Authors: W Andrew Mould; J Ricardo Carhuapoma; John Muschelli; Karen Lane; Timothy C Morgan; Nichol A McBee; Amanda J Bistran-Hall; Natalie L Ullman; Paul Vespa; Neil A Martin; Issam Awad; Mario Zuccarello; Daniel F Hanley Journal: Stroke Date: 2013-02-07 Impact factor: 7.914