[Thrombolysis in central retinal artery occlusion using alteplase]

Area of Science:

• Ophthalmology
• Vascular Medicine
• Pharmacology

Context:

• Central retinal artery occlusion (CRAO) and branch retinal artery occlusion (BRAO) are critical conditions leading to vision loss.
• Systemic thrombolysis, a fibrinolytic therapy, is an underutilized treatment option for acute retinal artery occlusions.
• This study evaluates the initial outcomes of systemic thrombolysis for CRAO and BRAO.

Purpose:

• To assess the efficacy and safety of systemic thrombolysis with alteplase for acute retinal artery occlusions.
• To determine the optimal time window for thrombolytic treatment in retinal artery occlusion.
• To identify patient selection criteria and necessary monitoring protocols for this treatment.

Summary:

• Five patients with retinal artery occlusions (two BRAO, three CRAO) received intravenous alteplase (0.9 mg/kg).
• Visual acuity improved significantly in four out of five patients, with notable recovery in CRAO cases treated within 18 hours.
• One patient with a >30-hour latency experienced transient improvement followed by vision loss.

Impact:

• Systemic thrombolysis demonstrates a significant advantage over conservative management for acute retinal artery occlusions.
• Early intervention (within 18 hours) is critical for successful visual recovery.
• Careful patient selection, considering contraindications, and intensive monitoring are essential for safe and effective thrombolytic therapy.