Efficacy and safety of intra-arterial thrombolysis in central retinal artery occlusion
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Published on: January 18, 2018
Seong Joon Ahn1, Jae Min Kim, Jeong-Ho Hong
1Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.
Insights
Intra-arterial thrombolysis (IAT) shows promise for acute central retinal artery occlusion (CRAO), particularly in incomplete cases. This treatment may improve vision and restore retinal perfusion faster than standard methods.
Area of Science:
- Ophthalmology
- Vascular Neurology
Background:
- Central retinal artery occlusion (CRAO) is a critical condition leading to vision loss.
- Standard treatments for CRAO have limited efficacy.
- Intra-arterial thrombolysis (IAT) is an emerging therapeutic option.
Purpose of the Study:
- To evaluate the efficacy and safety of intra-arterial thrombolysis (IAT) for acute central retinal artery occlusion (CRAO).
Main Methods:
- Retrospective review of 101 CRAO patients: 57 treated with IAT and 44 with standard treatment (ST).
- CRAO categorized as incomplete, subtotal, or total based on fundoscopic and angiographic findings.
- Comparison of visual acuity and reperfusion rates between IAT and ST groups, with subgroup analysis by CRAO stage.
Main Results:
- IAT demonstrated significantly higher early reperfusion rates (74.1% vs. 42.9%).
- In incomplete CRAO, IAT led to greater visual improvement at 1 month and final follow-up.
- No significant visual outcome differences were found in subtotal or total CRAO.
- IAT had a low rate of clinically insignificant cerebral infarcts (8%) with no hemorrhagic transformation.
Conclusions:
- IAT may offer early restoration of retinal perfusion.
- IAT shows functional benefits in managing incomplete CRAO.
- Further research may explore IAT's role in different CRAO severities.
Purpose:
To investigate the efficacy and safety of intra-arterial thrombolysis (IAT) for acute central retinal artery occlusion (CRAO).
Methods:
Records from 101 CRAO patients treated with either IAT (n = 57) or standard treatment (ST; n = 44) were retrospectively reviewed. ST consisted of ocular massage and intraocular pressure-lowering agents. We used fundoscopic and angiographic findings to categorize CRAO as incomplete (diminished visual acuity [VA] with slight retinal edema, slight cherry-red spot), subtotal (severe VA reduction, cherry-red spot, distinct retinal edema), or total (massive edema, occluded perimacular arterioles, additional choroidal blood flow interruption). One-month and final best-corrected VA (BCVA) of the IAT group were compared with those of the ST group. Early (≤3-day) and final (1-month) reperfusion (improvement of retinal perfusion) rates were compared between groups. Subgroup analyses were performed according to CRAO stage.
Results:
Overall, VA did not significantly differ between groups, but early reperfusion was greater in the IAT group (74.1% vs. 42.9%, P = 0.005). In incomplete CRAO, the IAT group exhibited greater visual improvement after 1 month (1.08 ± 0.21 vs. 0.23 ± 0.26 logarithmic values of the minimum angle of resolution [logMAR], P < 0.001) and at the final visit (1.08 ± 0.53 vs. 0.08 ± 0.57 logMAR, P < 0.001). However, in subtotal and total CRAO, no significant differences in visual outcomes were observed between groups. IAT resulted in clinically insignificant cerebral infarcts, detectable on brain imaging, in 8% of patients. Hemorrhagic transformation was not noted.
Conclusions:
The IAT treatment may provide early restoration of retinal perfusion and offer functional benefits in the management of incomplete CRAO.
