Intravenous thrombolysis in central retinal artery occlusion as an effective and safe treatment

Central retinal artery occlusion (CRAO) is a relatively rare but underestimated medical emergency leading to severe vision loss. It is considered the ocular equivalent of ischemic stroke. There is still no definite recommendation for treatment. Currently considered and one of the increasingly preferred options is intravenous thrombolysis (IVT). Presented here are the results of a multicenter retrospective study to assess the safety and effectiveness of thrombolytic treatment in CRAO.

All patients with CRAO from eight centers who received IVT were included in the retrospective study. The effectiveness of the intervention was evaluated in two stages. The first stage was when the residual vision in the affected eye was achieved at least to the level of the ability to orientate in space (recognizing contours). The second stage was the improvement of vision to recognize objects and faces. The effectiveness was further evaluated depending on the duration of the difficulties before the intervention. Safety was assessed based on the symptomatic intracerebral hemorrhage (SICH).

Sixty-four patients (age 67.9 ± 12.0 years, 51.6% men) were treated for CRAO with IVT. The median time from onset of symptoms to treatment was 4.5 hours. Improvement after treatment occurred in 60.9% (recognition of contours) and significant improvement in 39.1% (recognition of faces, ability to read). Intracerebral hemorrhage occurred in 6.3%. One fatal SICH was recorded. Two patients had vitreous hemorrhage. In both cases, vision improved to excellent condition.

Treatment of CRAO with IVT can be considered effective and safe. Secondary prevention should be in line with acute ischemic stroke (AIS) standards.