Streptokinase in central retinal vein occlusion: a controlled clinical trial.

Abstract

550BRITISH MEDICAL JOURNAL 6 MARCH 1976 waiting time for transplantation-now averaging two years'-are self evident. This series shows the value of HLA matching of donor and recipient for two, three, or four antigens, which was particularly important for the long-term survival of the transplants. As 77°o f transplant failures after 12 months were due to rejection it appears that close HLA matching of donor and recipient confers considerable benefit in decreasing kidney loss due to late rejection. The importance of the first transplant, which had significantly the lowest primary failure rate as compared with second and third transplants, was also evident, despite the second and third transplants being performed only in the absence of recipient cytotoxic and haemagglutinating antibodies to donor tissue. Analysis of the causes of the loss of transplants (table II) shows that rejection was responsible in 520(1 of cases, that the death of the patieUt with a functioning transplant was responsible in 30o0, that renal vascular thrombosis was responsible in 120o, and that miscellaneous causes, including urinary leak and kidney necrosis due to causes other than rejection, were responsible in 60°0. Transplant loss due to renal vascular thrombosis and miscellaneous causes resulted mainly from using cadaver kidneys unsuitable for transplantation. These kidneys, which originated from non-ventilated donors or had vascular anomalies or prolonged ischaemic times, constituted half of the primary failures, and elimination of these high-risk kidneys has been shown to reduce the primary failure rate from 210°overall to 11Q,, which was due mainly to rejection. The incidence of rejection may be reduced by close HLA matching of donor and recipient. When the donor and recipient had two or more antigens in common the three-year kidney survival rate was 460, as opposed to 9 50o for poorer matches. Altogether 21 0°o f the patients died with functioning transplants and 40°,, of the deaths appeared to be due to infections with bacteria sensitive to conventional antibiotics. Intensive antibiotic treatment sometimes failed in the immunosuppressed patient owing to the emergence of resistant bacteria, opportunistic organisms, and infection with several different organisms. The importance of using only low-risk kidneys with the best possible HLA matching and scrupulous patient care is shown by the finding that if the patient survives one year with a functioning transplant there is a 770 chance of surviving to at least three years with satisfactory renal function. Clearly for the results of cadaver kidney transplantation to be improved more kidneys are required from well maintained donors to enable the strict selection of only kidneys that are suitable for transplantation to be made. Then the three-year functioning kidney transplant survival rate should improve to more than 50%' instead of the 3100, reported at present. For this to be achieved changes will be required in both medical and public attitudes that prevail in Britain to cadaver kidne...

Visual Outcome after Treatment with Low-Dose Recombinant Tissue Plasminogen Activator or Hemodilution in Ischemic Central Retinal Vein Occlusion

“…Our findings parallel those reported by other investigators who found a beneficial effect of thrombolysis in retinal vein occlusion. Kohner et al [23]investigated the efficacy of streptokinase in CRVO in a controlled clinical trial. The visual outcome in their treatment group was significantly better than in controls; however, the use of streptokinase resulted in vitreous hemorrhage with permanent loss of vision in 3 of 20 patients [23].…”

“…Kohner et al [23]investigated the efficacy of streptokinase in CRVO in a controlled clinical trial. The visual outcome in their treatment group was significantly better than in controls; however, the use of streptokinase resulted in vitreous hemorrhage with permanent loss of vision in 3 of 20 patients [23]. In another study, a more favorable outcome after treatment of CRVO and branch retinal vein occlusion with streptokinase in comparison to anticoagulant therapy with heparin was observed [25].…”

“…Moreover, the spectrum of indications for thrombolytic drugs such as streptokinase or recombinant tissue plasminogen activator (rtPA) comprises lung embolism, ischemic stroke, deep-vein thrombosis and acute arterial occlusions of the lower limbs [17, 18, 19, 20]. In contrast, the use of thrombolytic agents in retinal vessel occlusion is in its infancy, although several studies have indicated that fibrinolysis may be associated with a better visual prognosis in CRVO [21, 22, 23, 24, 25]. Since, basically, it is of some concern that the systemic administration of fibrinolytic agents carries a risk of bleeding, the choice of an appropriate intravenous thrombolytic therapy in a non-life-threatening situation should be based on minimizing the probability of potential complications.…”

Fibrinolytic and Surgical Treatment Approaches for Retinal Vein Occlusion

“…Fibrinolytic treatment of RVO based on the thrombotic pathogenesis of the disease and administration of fibrinolytic agent may the recanalize the obstructed vein by lysing the thrombus [12] . Some studies showed that despite systemic thrombolitic agents have beneficial effects on the blood flow of the obsructed retinal vein and improvement in visual acuity, these systemic agents associated with some side effects as massive subretinal haemorrhage, vitreous haemorrhage, gastrointestinal haemorrhage, serebral haemorrhage even death [9,[13][14][15] . Because of the serious side effects, systemic fibrinolytic agents are not prefered for RVO anymore.…”

Intravitreal Injection of Tissue Plasminogen Activator for Central Retinal Vein Occlusion.

“…[8][9][10][11][12] Because of systemic risks, this approach has not been widely adopted or definitively studied. To limit the systemic side effects, investigators have used other approaches to deliver the thrombolytic agent locally, such as intravitreal injection and intravenous retinal cannulization.…”