Endoscopic Retinal Endovascular Thrombolysis (E-RET):
A Novel Approach to the Management of Retinal Vessel Occlusion
Lars-Olof Hattenbach, A. Mirshahi, I. Hilgenberg (Ludwigshafen)
Background: The choice of an appropriate thrombolytic therapy in retinal vessel occlusion
should be based on minimizing the probability of potential hemorrhagic complications. Recent
studies suggest that the cannulation of retinal vessels may provide a potential access route for
the administration of fibrinolytic agents. However, the major problem with available techniques
is the limited visualization of retinal vessels with conventional surgical microscopes, making it
difficult to effectively control the targeted injection of drugs. Here, we present a device for the
endoscopically guided puncture of microvessels which may be effective in the treatment of retinal
vascular occlusive diseases.
Methods: We developed a novel single piece catheter system for the endoscopically guided puncture of microvessels.
Experimental punctures of branch retinal veins with injection of fluid were performed in porcine cadaver eyes using a
standard high resolution gradient index microendoscope introduced through the pars plana.
Results: Endoscopically guided punctures were successfully performed in branch retinal veins with an outer diameter of
approximately 50-60 mm. Injection of fluid into the vessel lumen was accomplished under direct endoscopic view in a safe
and reliable manner.
Conclusions: The findings of this experimental study support the concept of retinal endovascular thrombolysis as a promising
therapeutic approach to retinal vascular occlusive diseases. The endoscopically guided delivery of drugs to retinal vessels
has the potential to improve safety and effectiveness of this treatment strategy.