Fibrinolytic therapy aimed at early restoration of blood flow appears to be a promising therapeutic approach in haemorrhagic retinopathy. The risk of bleeding complications, a major problem with fibrinolysis, can be reduced by the use of low-dose thrombolytic regimens. In our study, 14 patients with ischaemic central (CRVO) or branch (BRVO) retinal vein occlusion who presented with severe visual loss and recent onset of symptoms were treated with a low dose (50 mg) of recombinant tissue plasminogen activator (rt-PA) and intravenous heparin. In 10 of 14 patients (7 CRVO, 3 BRVO), an increase in visual acuity of one line or more on the logarithmic visual acuity chart was noted and in 8 patients (6 CRVO, 2 BRVO) a reduction of areas of capillary non-perfusion was observed, suggesting that a restoration of retinal capillary blood flow can be achieved if fibrinolysis is initiated in the early phase of haemorrhagic retinopathy. In view of the poor prognosis in the natural course of haemorrhagic retinopathy and the potential haemorrhagic risk in fibrinolysis, the use of low-dose rt-PA appears to constitute an encouraging approach in the management of this disease.

Intraocular application of rt-PA appears to be a safe and efficacious therapeutic approach in the management of severe fibrinous reactions after pediatric cataract surgery.

The ischemic type of central retinal vein occlusion (CRVO) is associated with a poor visual and ocular prognosis. Although several reports have indicated that hemodilution or thrombolytic therapy may be of benefit, there is still no consensus among ophthalmologists about the management of this disorder. In our study, we retrospectively evaluated the visual outcome after medical treatment in 58 patients with ischemic CRVO and severe visual loss (≤20/50). We separately investigated three different groups, depending on the following criteria: onset of symptoms within 11 days prior to admission and thrombolytic treatment with 50 mg of recombinant tissue plasminogen activator (rtPA) and intravenous heparinization (n = 23) or hemodilution therapy (n = 22) or onset of symptoms >11 days before the initial visit and hemodilution (n = 13). An advancement of 2 or more lines on the logarithmic visual acuity chart was noted in 10 cases (44%) in the rtPA group and in 3 subjects (14%) in the early-phase hemodilution group, whereas only 1 patient in the late-phase hemodilution group showed a comparable improvement. Our findings suggest that treatment with low-dose rtPA or hemodilution aimed at early restoration of blood flow has the potential to improve the visual prognosis in ischemic CRVO. The finding that thrombolysis had a favorable outcome supports the hypothesis that specific subgroups of patients may benefit from this therapeutic approach. Further investigation will be required to definitively prove the effectiveness of fibrinolytic agents.

LASIK with superior hinge and scanning spot excimer photoablation is suitable for the correction of myopia (up to a maximum of -12 D) and for myopic astigmatism (up to a maximum of -5 D). The refractive results showed a high stability during the 12-month study period but there is still room for improvement of the predictability.