To investigate the effect of intravitreal recombinant tissue plasminogen activator (rt-PA) injection before vitrectomy on surgical facility and outcome in diabetic tractional retinal detachments (TRD).
Methods
Prospective, randomized, interventional clinical trial. A total of 38 eyes with diabetic TRD were candidates for vitrectomy. Patients were randomized 1:1 to receive intravitreal rt-PA, five to seven days before vitrectomy or no injection. Intraoperative surgical facility and anatomic success at month 3 after surgery were assessed.
Results
Mean patient age was 54.2 ± 9.4 years. There was no statistically significant difference between rt-PA and no injection groups with regard to anatomic success (89% versus 95%, respectively, P = 0.547) and best corrected visual acuity at 3 months (2.0 versus 2.1 logMAR, respectively, P = 0.840). However, surgical facility score was statistically significantly lower in rt-PA injection group compared to no injection group (4.1 ± 1.7, 5.8 ± 2.0, respectively, P = 0.007).
Conclusions
Vitrectomy for TRD was easier after preoperative rt-PA injection, without affecting the anatomic and visual outcomes.
Diabetes Control and Complications Trial Research Group. Progression of retinopathy with intensive versus conventional treatment in the diabetes control and complications trial. Ophthalmology1995; 102: 647–661.
2.
FlynnHWChewEYSimonsBD, et al.Pars plana vitrectomy in the early treatment diabetic retinopathy study. ETDRS report number 17. The early treatment diabetic retinopathy study research group. Ophthalmology1992; 99: 1351–1357.
3.
CharlesS. Principles and techniques of vitreoretinal surgery. In: SchachatAPWilkinsonCHintonDR, et al. (eds) Ryan’s Retina. Elsevier, 2017, pp.1916–1922.
4.
ZhaoX-YXiaSChenY-X. Antivascular endothelial growth factor agents pretreatment before vitrectomy for complicated proliferative diabetic retinopathy: a meta-analysis of randomised controlled trials. Br J Ophthalmol2018; 102: 1077–1085.
5.
ZhaoL-QZhuHZhaoP-Q, et al.A systematic review and meta-analysis of clinical outcomes of vitrectomy with or without intravitreal bevacizumab pretreatment for severe diabetic retinopathy. Br J Ophthalmol2011; 95: 1216–1222.
6.
ModarresMNazariHFalavarjaniKG, et al.Intravitreal injection of bevacizumab before vitrectomy for proliferative diabetic retinopathy. Eur J Ophthalmol2009; 19: 848–852.
7.
ZhangZ-HLiuH-YHernandez-Da MotaSE, et al.Vitrectomy with or without preoperative intravitreal bevacizumab for proliferative diabetic retinopathy: a meta-analysis of randomized controlled trials. Am J Ophthalmol2013; 156: 106–115.e2.
KameiMEstafanousMLewisH. Tissue plasminogen activator in the treatment of vitreoretinal diseases. Semin Ophthalmol2000; 15: 44–50.
10.
Casaroli MaranoRPVilaróS. The role of fibronectin, laminin, vitronectin and their receptors on cellular adhesion in proliferative vitreoretinopathy. Invest Ophthalmol Vis Sci1994; 35: 2791–2803.
11.
GokMKarabaşVLAslanMS, et al.Tissue plasminogen activator-assisted vitrectomy for submacular hemorrhage due to age-related macular degeneration. Indian J Ophthalmol2017; 65: 482–487.
MurakamiTTakagiHOhashiH, et al.Role of posterior vitreous detachment induced by intravitreal tissue plasminogen activator in macular edema with central retinal vein occlusion. Retina2007; 27: 1031–1037.
14.
RaczyńskaDLipowskiPZorenaK, et al.Enzymatic vitreolysis with recombinant tissue plasminogen activator for vitreomacular traction. Drug Des Devel Ther2015; 9: 6259–6268.
15.
CastellarinAGrigorianRBhagatN, et al.Vitrectomy with silicone oil infusion in severe diabetic retinopathy. Br J Ophthalmol2003; 87: 318–321.
16.
Ghasemi FalavarjaniKModarresMHadavandkhaniA, et al.Intra-silicone oil injection of methotrexate at the end of vitrectomy for advanced proliferative diabetic retinopathy. Eye2015; 29: 1199–1203.
17.
HolladayJT. Proper method for calculating average visual acuity. J Refract Surg1997; 13: 388–391.
18.
Standards of Medical Care in Diabetes—2017. Summary of revisions. Diabetes Care2017; 40: S4–S5.
19.
Le MerYKorobelnikJFMorelC, et al.TPA-assisted vitrectomy for proliferative diabetic retinopathy: results of a double-masked, multicenter trial. Retina1999; 19: 378–382.
20.
IyerSSRReganKABurnhamJM, et al.Surgical management of diabetic tractional retinal detachments. Surv Ophthalmol2019; 64: 780–809.
21.
RamezaniAAhmadiehHRozegarA, et al.Predictors and outcomes of vitrectomy and silicone oil injection in advanced diabetic retinopathy. Korean J Ophthalmol2017; 31: 217–229.
22.
DogramaciMLeeEJKWilliamsonTH. The incidence and the risk factors for iatrogenic retinal breaks during pars plana vitrectomy. Eye (Lond)2012; 26: 718–722.
23.
ThompsonJTde BustrosSMichelsRG, et al.Results and prognostic factors in vitrectomy for diabetic traction retinal detachment of the macula. Arch Ophthalmol (Chicago, Ill 1960)1987; 105: 497–502.
WuW-CDrenserKALaiM, et al.Plasmin enzyme-assisted vitrectomy for primary and reoperated eyes with stage 5 retinopathy of prematurity. Retina2008; 28: S75–S80.
26.
TsukaharaYHondaSImaiH, et al.Autologous plasmin-assisted vitrectomy for stage 5 retinopathy of prematurity: a preliminary trial. Am J Ophthalmol2007; 144: 139–141.
27.
LeeY-SWangN-KChenY-P, et al.Plasmin enzyme-assisted vitrectomy in pediatric patients with vitreoretinal diseases. Ophthalmic Res2016; 56: 193–201.
DaruichAParcqJDelaunayK, et al.Retinal safety of intravitreal rtPA in healthy rats and under excitotoxic conditions. Mol Vis2016; 22: 1332–1341.
30.
TsuikiEKusanoMKitaokaT. Complication associated with intravitreal injection of tissue plasminogen activator for treatment of submacular hemorrhage due to rupture of retinal arterial macroaneurysm. Am J Ophthalmol Case Reports2019; 16: 100556.
31.
KokameGT. Vitreous hemorrhage after intravitreal tissue plasminogen activator (t-PA) and pneumatic displacement of submacular hemorrhage. Am J Ophthalmol2000; 129: 546–547.
32.
Ghasemi FalavarjaniKAnvariPDehghan NiriM, et al.The effect of intravitreal recombinant tissue plasminogen activator injection on diabetic tractional fibrovascular membranes: proposed criteria using optical coherence tomography. Eur J Ophthalmol2021; 32: 112067212199822.
