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Reperfusion of Large Ischemic Areas Associated With Central Retinal Vein Occlusion A Potential Novel Treatment With Activated Protein C

Motohiro Kamei, MD, PhD1; Nagakazu Matsumura, MD, PhD1; Mihoko Suzuki, MD, PhD1; Susumu Sakimoto, MD, PhD1; Hirokazu Sakaguchi, MD, PhD1; Kohji Nishida, MD, PhD1
[+] Author Affiliations
1Department of Ophthalmology, Osaka University Graduate School of Medicine, Osaka, Japan
JAMA Ophthalmol. 2014;132(3):361-362. doi:10.1001/jamaophthalmol.2013.6334.
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Central retinal vein occlusion (CRVO) severely threatens vision, especially in ischemic CRVO, for which no effective treatment has been established. Photocoagulation is the only treatment for retinal ischemia, which restores a balance between oxygen supply and demand by reducing the number of retinal cells. Considering its destructiveness, photocoagulation is not ideal. We report 2 cases with ischemic CRVO in which reperfusion of large ischemic areas occurred after novel treatment with an intraocular injection of activated protein C (APC).

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Figure 1.
Fluorescein Angiography of the Right Eye in Case 1

A, Fluorescein angiography of the right eye shows large hypofluorescent areas resulting from nonperfusion of the retinal capillaries (red arrowheads) and small areas of blockage caused by retinal hemorrhages (blue arrowheads). B, Fluorescein angiography performed 3 months after treatment shows a reduction in the area of nonperfusion (arrowheads), but about 9.6 disc areas of ischemia remain. C, Fluorescein angiography performed 10 months after treatment shows that all areas of nonperfusion have resolved completely and the microcirculation is almost normal.

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Figure 2.
Fluorescein Angiography of the Left Eye in Case 2

A, Fluorescein angiography of the left eye shows large hypofluorescent areas of nonperfusion of the retinal capillaries. B, Fluorescein angiography performed 6 months after treatment shows almost normal microcirculation with small patchy areas of nonperfusion (arrowheads).

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