Treatment of Central Retinal Arterial Occlusion Using Ultrasound-stimulated Microbubbles

Central retinal artery occlusion (CRAO) is an acute that can result in irreversible vision loss and blindness. However, the efficacy of conventional treatments for retinal artery recanalization and vision restoration remains uncertain. The objective of our study was to evaluate effectiveness and potential side effects of conventional multimodal treatment (CMT) combined with ultrasound-stimulated microbubbles (USMB) in the patients with CRAO.

In this nonconcurrent controlled trial, 34 CRAO patients were consecutively enrolled in the USMB group (CMT+ USMB). USMB was performed using a commercially available diagnostic ultrasound (US) device with a clinical US contrast agent (microbubbles, MBs). Twenty-three CRAO patients treated only with CMT were assigned to the CMT group (historical control). The primary endpoint was best-corrected visual acuity (BCVA; converted to logMAR) at the initial and follow-up visits, and the secondary endpoint was safety. Fundus photography and optical coherence tomography (OCT) were performed in the USMB group upon admission and within 24 h of USMB treatment.

Of 64.7% (22/34) of patients showed clinically significant visual improvement (≥+0.3 logMAR) in the USMB group at 3 mo follow-up, compared to only 21.7.0% (5/23) in the CMT group (p < 0.001). Fundus photography and OCT demonstrated the safety performance of USMB for patients with CRAO. The combined therapeutic regimen did not induce any additional toxicity or increased frequency of side effects when compared to CMT alone (p > 0.05).

USMB-augmented CMT may improve the clinical efficacy of CRAO patients, with sustained stability of visual recovery at 3-mo follow-up. This innovative non-invasive approach offers excellent clinical safety and feasibility for acute CRAO management.