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Updated: Jan 15, 2026
Combined Near-infrared Fluorescent Imaging and Micro-computed Tomography for Directly Visualizing Cerebral Thromboemboli
Published on: September 25, 2016
Visual outcome comparison of intravenous thrombolysis after central retinal artery occlusions
Daniel X Chen1, Bobeck S Modjtahedi2, Alex T Vo3
1Department of Clinical Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA, USA.
Background:
Central retinal artery occlusions (CRAOs) are an important cause of vision loss that lacks standardized emergent treatment. While intravenous thrombolysis is effective in acute ischemic stroke, its safety and efficacy in CRAOs remain unclear. This study compares visual outcomes of patients with CRAOs treated with intravenous thrombolysis versus medical management (MM).
Methods:
A retrospective cohort study was done of patients with acute CRAOs presenting with count fingers or worse. Patients receiving thrombolysis tenecteplase (TNK) or tissue plasminogen activator (tPA)] were matched to those who received MM without thrombolysis based on age, gender, hypertension, diabetes, and hyperlipidemia. Groups included 20 TNK, 19 tPA, and 39 MM patients. Primary outcomes were average visual acuity (logMAR) and proportion of patients with >20/200 vision at initial and final visit within 6 months of CRAO diagnosis. Multivariate regression controlled for demographics, comorbidities, and non-thrombolytic treatments.
Results:
Better than 20/200 vision was more common in those who received TNK than MM at first follow-up [OR: 6.70, 95 % CI: (1.25, 46.4), p = 0.04]. Similarly, patients receiving TNK had significantly better average visual acuity compared to MM on the first (-0.60 logMAR difference (95 % CI: (-1.0, -0.16), p = 0.008) and final (-0.60 logMAR difference 95 % CI: (-1.1, -0.12), p = 0.01) follow-up. No symptomatic intracranial hemorrhages or intraocular hemorrhages occurred within one week following treatment.
Conclusions:
Patients who received TNK had better visual outcomes than those treated with MM, a difference that was not seen with tPA use. These findings demonstrate a possible role for TNK in the management of CRAOs.
