Thrombolytic Therapy for Central Retinal Artery Occlusion in an Academic Multi-Site Stroke Centre

Area of Science:

• Ophthalmology
• Neurology
• Vascular Medicine

Background:

• Central retinal artery occlusion (CRAO) is a critical condition causing severe vision loss, often treated as an acute ischemic stroke.
• Recent guidelines suggest time-windows for thrombolysis in CRAO, mirroring acute cerebral stroke protocols.

Purpose of the Study:

• To review the academic stroke center's experience with intravenous (IVT) and intra-arterial thrombolysis (IAT) for CRAO.
• To compare visual acuity outcomes in thrombolysed CRAO patients versus a matched conservative therapy cohort.

Main Methods:

• Retrospective review of CRAO patients treated between 1997 and 2022.
• Collected demographic, clinical, thrombolysis timeline, and concurrent therapy data.
• Compared 3-month visual acuity between thrombolysed and conservatively treated patients.

Main Results:

• Thrombolysis was given to 3.55% of CRAO admissions (20 patients: 13 IVT, 7 IAT).
• IVT achieved ≥2 Snellen lines improvement in 25%; IAT in 42%. Intracranial hemorrhage occurred in 7.6% of IVT cases.
• No significant difference in 3-month visual acuity was found between thrombolysis and conservative therapy groups.

Conclusions:

• Acute CRAO management remains heterogeneous.
• Thrombolysis did not demonstrate a clear benefit in this series, highlighting the need for randomized trials.
• Further research is required to establish optimal hyperacute CRAO management strategies.