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Intra-arterial thrombolysis for central retinal artery occlusion: a systematic review
J Noble1, N Weizblit, M O Baerlocher
1Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Canada. jason.noble@utoronto.ca
Insights
Intra-arterial thrombolysis (IAT) shows promise for central retinal artery occlusion (CRAO) treatment, with high visual improvement rates. However, more research is needed to confirm its routine use for CRAO.
Area of Science:
- Ophthalmology
- Vascular Medicine
- Interventional Neurology
Background:
- Central retinal artery occlusion (CRAO) is a critical condition causing vision loss.
- Intra-arterial thrombolysis (IAT) is an emerging treatment option for CRAO.
- Evidence for IAT's efficacy in CRAO requires updated analysis.
Purpose of the Study:
- To review and analyze the current evidence for intra-arterial thrombolysis (IAT) in treating central retinal artery occlusion (CRAO).
- To assess the visual outcomes and complication rates associated with IAT for CRAO.
Main Methods:
- Systematic review of literature indexed by Ovid MEDLINE.
- Search terms included "central retinal artery occlusion," "thrombolysis," "intra-arterial," and "fibrinolysis."
- Included studies with five or more patients; analyzed data statistically.
Main Results:
- Eight studies with 158 patients met the inclusion criteria.
- Treatment was initiated within an average of 8.4 hours of symptom onset.
- Visual improvement occurred in 93% of patients; complications in 4.5%.
Conclusions:
- IAT may offer superior visual outcomes for CRAO compared to conventional treatments in specific scenarios.
- Current evidence is insufficient to recommend routine IAT for CRAO.
- Well-designed, prospective, randomized trials are necessary to establish definitive guidelines.
Introduction:
This review provides an updated analysis of the evidence supporting intra-arterial thrombolysis (IAT) for the treatment of central retinal artery occlusion (CRAO).
Methods:
A systemic review of the literature indexed by Ovid MEDLINE was performed for the following medical subject headings: central retinal artery occlusion, thrombolysis, intra-arterial, fibrinolysis. Studies were analysed individually and categorised by study type, and extracted data grouped together for statistical analysis. Only studies with five patients or more were included in the review.
Results:
Twenty-three studies were identified in the original search; eight were selected for the analysis. Of these studies, 158 patients were represented, in which treatment was instituted within an average of 8.4 (SD 4) h of symptom onset. In these patients, visual improvement occurred on average in 93% of patients, with 13% achieving 20/20 or better, 25% achieving 20/40 or better, and 41% achieving 20/200 or better. Complications occurred in 4.5% of cases.
Conclusion:
IAT may produce superior visual outcomes compared with conventional treatments for CRAO when instituted in certain situations. At the moment, there is insufficient evidence to support the routine use of IAT to treat CRAO. Well-designed prospective, randomised trials remain to be done.
