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Another One: A Novel Variant Associated With Leber Hereditary Optic Neuropathy.

Journal of neuro-ophthalmology : the official journal of the North American Neuro-Ophthalmology Society·2025
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IV Thrombolysis for central retinal artery occlusion - Real-world experience from a comprehensive stroke center.

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Updates in Central Retinal Artery Occlusion.

John E Paddock1, Tatiana V Bakaeva

  • 1Department of Ophthalmology (JEP), Weill Cornell Medicine, New York, New York; Department of Neurology (JEP), Weill Cornell Medicine, New York, New York; and Departments of Neurology and Surgery (TVB), Warren Alpert Medical School at Brown University, Providence, Rhode Island.

Journal of Neuro-Ophthalmology : the Official Journal of the North American Neuro-Ophthalmology Society
|February 17, 2026
PubMed
Summary
This summary is machine-generated.

Central retinal artery occlusion (CRAO) is an eye emergency. Prompt intravenous thrombolysis within 4.5 hours offers the best chance for vision recovery, treating it like an acute ischemic stroke.

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Area of Science:

  • Neuro-ophthalmology
  • Vascular Neurology
  • Emergency Medicine

Background:

  • Central retinal artery occlusion (CRAO) is a critical neuro-ophthalmic emergency with outcomes similar to acute ischemic stroke.
  • Limited treatment options and a lack of robust clinical trials hinder effective management of CRAO.
  • Timely intervention is crucial for preserving vision in CRAO cases.

Purpose of the Study:

  • To review current evidence on the emergent management and evolving treatment strategies for CRAO.
  • To synthesize findings from observational studies, meta-analyses, and early randomized trials.
  • To provide an updated perspective on CRAO treatment.

Main Methods:

  • Systematic review of recent observational studies, meta-analyses, and early randomized trials.
  • Analysis of emergent management and evolving treatment strategies for CRAO.
  • Evaluation of conservative and interventional treatment options.

Main Results:

  • Conservative treatments (ocular massage, paracentesis, vasodilators) show no benefit and may be harmful.
  • Intravenous thrombolysis with recombinant tissue plasminogen activator (t-PA) within 4.5 hours offers the strongest evidence for visual recovery.
  • Intra-arterial thrombolysis may extend the treatment window, but results are inconsistent; teleophthalmology and AI improve diagnosis; hyperbaric oxygen may be adjunctive.

Conclusions:

  • CRAO management should mirror acute ischemic stroke protocols.
  • Thrombolysis within 4.5 hours presents the highest potential for visual recovery in CRAO.
  • Further randomized trials are essential to optimize CRAO efficacy, safety, and management; public awareness and streamlined protocols are vital.