Retinal toxicity of intravitreal tissue plasminogen activator: Case report and literature review

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 μg) 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 μg) may be toxic to the human retina.