Combined Intravitreal Bevacizumab and Tissue Plasminogen Activator for Treatment of Retinal Vascular Diseases

To evaluate the effects of combined intravitreal tissue plasminogen activator (TPA) and bevacizumab on retinal vascular diseases. In this prospective, interventional case series, a total of 19 eyes from 19 patients with retinal vascular diseases, including diabetic macular edema (DME), diabetic vitreous hemorrhage (VH), central retinal vein occlusion (CRVO), and neovascular age related macular degeneration (AMD) received combined intravitreal TPA (50 μg) and bevacizumab (1.25 mg). The measurement of best corrected visual acuity, B-scan, and OCT was performed at the baseline and 1 month after injections. The mean age of the patients was 56.8 years. Eight patients (42.1%) were male and 11 patients (57.9%) were female. Seventeen eyes (89.4%) were phakic and 2 eyes (10.6%) were pseudophakic. The incidence of posterior vitreous detachment (PVD) was 57.8% (11 of 19). One month after intravitreal injections, best corrected visual acuity (BCVA) improved (P=0.005) and central macular thickness (CMT) decreased (P=0.013) significantly. Decrement of CMT was significantly greater in PVD positive eyes compared with PVD negative eyes (P=0.014). Combined intravitreal injection of bevacizumab and TPA was significantly related with increase in BCVA and decrease in CMT and PVD.