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Intravenous thrombolysis in patients with central retinal artery occlusion: a systematic review and meta-analysis

Lele Huang1, Yujie Wang2, Ruijun Zhang3

  • 1Department of Ophthalmology, The First Hospital of China Medical University, 155 Nanjingbei Street, Heping District, Shenyang, 110001, People's Republic of China.

Journal of Neurology
|October 9, 2021
PubMed

Insights

Intravenous thrombolysis (IVT) with alteplase shows potential for improving vision in central retinal artery occlusion (CRAO) patients. While IVT may enhance best-corrected visual acuity, final outcomes can be influenced by ocular complications unrelated to the treatment.

Area of Science:

  • Ophthalmology
  • Neurology
  • Vascular Medicine

Background:

  • Central retinal artery occlusion (CRAO) is a critical condition leading to vision loss.
  • Investigating effective treatments for CRAO is essential for preserving sight.

Purpose of the Study:

  • To evaluate the efficacy and safety of intravenous thrombolysis (IVT) using alteplase in patients diagnosed with CRAO.
  • To determine the impact of IVT on visual acuity outcomes in CRAO patients.

Main Methods:

  • A systematic literature search was conducted on PubMed and EMBASE for studies on IVT in CRAO patients up to May 19, 2021.
  • Pooled analysis of best-corrected visual acuity (BCVA) improvement rates and mean differences (MD) using random effects models.
  • Included 8 studies with 316 CRAO patients (157 treated with IVT, 159 controls).

Main Results:

  • The rate of best BCVA improvement was significantly higher in the IVT group (47%) compared to the control group (12%) (OR 5.97).
  • Patients receiving IVT showed better best BCVA (MD [logMAR] -0.23) compared to controls, despite similar baseline BCVA.
  • No significant difference in final BCVA was observed between groups (MD [logMAR] -0.10).
  • Two patients experienced symptomatic intracranial hemorrhage post-IVT.

Conclusions:

  • Intravenous thrombolysis with alteplase may be an effective and safe treatment option for CRAO.
  • Ocular-specific complications, independent of thrombolysis, can negatively impact final visual acuity in CRAO patients.
  • Further research may be needed to optimize IVT protocols and manage potential complications.
Abstract

Keywords:
Best-corrected visual acuityCentral retinal artery occlusionIntravenous thrombolysisMeta-analysis

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