# Is Intravitreal Injection of Recombinant Tissue Plasminogen Activator Effective for the Treatment of Refractory Diabetic Macular Edema in Patients With Posterior Vitreous Detachment?

## TL;DR

This study found that injecting a drug called rTPA into the eye did not improve vision or reduce swelling in patients with diabetic eye disease who already had a specific eye condition called PVD.

## Contribution

The study evaluates the effectiveness of rTPA in a specific subgroup of DME patients with PVD, finding no significant benefit.

## Key findings

- Intravitreal rTPA did not significantly reduce central macular thickness in patients with refractory DME and PVD.
- There was no significant improvement in visual acuity after rTPA injections in the study group compared to the control group.
- The results suggest that prior improvements in macular thickness may be attributed to PVD rather than rTPA treatment.

## Abstract

Objective: To determine whether intravitreal injection of recombinant tissue plasminogen activator (rTPA) is effective for the treatment of refractory diabetic macular edema (DME) in patients who already had posterior vitreous detachment (PVD).

Methods: It is a retrospective chart review of the patients with refractory DME and PVD. The efficacy of intravitreal injection of rTPA was assessed based on the changes in central macular thickness (CMT) and best-corrected visual acuity (BCVA) in these patients.

Results: Nine eyes of nine patients as the study group and 14 eyes of the 14 patients as the control group were examined. Before the injections, the mean CMT was 470.0± 107.6 in the study group, compared to 536.2± 150.5 in the control group, with no statistical significance (p=0.403). The statistical analysis revealed no significant differences in the mean changes in CMT from baseline to one and three months after injections between the study and control groups (p=0.439, p=0.781, respectively). Likewise, no statistically significant disparities were observed in the mean pre-injection BCVA between the study group (0.877± 0.349) and the control group (0.950± 0.300) (p=0.415). Additionally, after three months of injection, there were no significant changes in the mean BCVA of the study group (0.844± 0.304) and the control group (0.864± 0.253) (p=0.512).

Conclusion: This study showed that rTPA has no effect on changes in CMT and BCVA in patients who had refractory DME and PVD at the same time. This may suggest that the improvement in CMT in previous studies may be due to the induction of PVD.