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Selective intra-arterial fibrinolysis of acute central retinal artery occlusion
J Weber1, L Remonda, H P Mattle
1Departments of Neuroradiology and Neurology, University of Bern, Bern, Switzerland.
Insights
Selective intra-arterial fibrinolysis improved vision in one-third of central retinal artery occlusion (CRAO) patients, offering a potential treatment for this condition. This study highlights the benefits of early blood flow restoration in CRAO cases.
Area of Science:
- Ophthalmology
- Vascular Neurology
- Interventional Radiology
Background:
- Central retinal artery occlusion (CRAO) leads to sudden, severe monocular vision loss.
- Prompt restoration of blood flow is crucial for improving visual outcomes in CRAO.
- Thromboembolic events are a common cause of CRAO.
Purpose of the Study:
- To evaluate the efficacy of selective intra-arterial fibrinolysis in treating central retinal artery occlusion.
- To assess the potential of early reperfusion therapy to improve visual acuity after CRAO.
Main Methods:
- Intra-arterial fibrinolysis using urokinase was administered to 17 patients within 6 hours of CRAO symptom onset.
- Treatment involved microcatheter infusion into the ophthalmic artery.
- A control group of 15 patients with CRAO who did not receive fibrinolysis was retrospectively evaluated for comparison.
Main Results:
- One-third of patients treated with intra-arterial fibrinolysis experienced complete (17.6%) or marked (11.8%) visual acuity improvement.
- Slight vision improvement was observed in 35.3% of fibrinolysis patients; 35.3% showed no improvement.
- In the control group, only 6.7% had partial vision improvement, with 66.7% showing no improvement.
Conclusions:
- Intra-arterial fibrinolysis demonstrated a potential to improve the typically poor visual outcome of central retinal artery occlusion.
- A significant proportion of CRAO patients achieved meaningful visual recovery with this interventional approach.
- The findings suggest that selective intra-arterial fibrinolysis is a promising therapeutic option for acute CRAO.
Background And Purpose:
Occlusion of the central retinal artery (CRAO) causes a sudden decrease of monocular vision. Because early restoration of blood flow may improve outcome, we attempted to treat CRAO with selective intra-arterial fibrinolysis.
Methods:
Intra-arterial fibrinolysis was performed within 6 hours after symptom onset in 17 patients with thromboembolic CRAO. Symptoms were painless, acute and severe decrease of vision. Urokinase (100 000 to 900 000 IU) was given through a microcatheter into the ophthalmic artery over 10 to 90 minutes. For comparison, the history and visual outcome of 15 control patients who did not receive fibrinolytics were evaluated. In both groups some of the patients underwent paracentesis and/or received carboanhydrase inhibitors.
Results:
Patients who underwent fibrinolysis fared better than control patients (P=0.01). Three patients (17.6%) recovered completely after fibrinolysis and regained visual acuity of 20/20 (n=2) to 25/20 (n=1). Two additional patients (11.8%) showed a marked improvement to a visual acuity of 20/30. In 6 patients (35. 3%) vision improved slightly. They were able to count fingers, detect hand movements, or perceive light. In 6 patients (35.3%), fibrinolytic treatment was without effect. Among control patients, 1 patient (6.7%) showed partial, 4 patients (26.7%) minimal, and 10 (66.7%) no improvement of vision.
Conclusions:
A complete or marked improvement of visual acuity was achieved in one third of intra-arterial fibrinolysis patients but in none of the control patients. Intra-arterial fibrinolysis seems to have the potential to "lighten" the spontaneously poor outcome of CRAO.