Evaluation of Ophthalmic Artery Branch Retrograde Intervention in the Treatment of Central Retinal Artery Occlusion (CRAO)

Abstract

BackgroundCentral retinal artery occlusion (CRAO) is the occlusion of the central retinal artery resulting in retinal infarction and acute vision loss. Digital subtraction angiography (DSA)–guided superselective ophthalmic artery or selective carotid thrombolysis remains the preferred treatment method for CRAO. This study aimed to evaluate the safety and clinical efficacy of the novel ophthalmic artery branch retrograde thrombolytic intervention for CRAO.Material/MethodsFifty patients with monocular CRAO were enrolled, including 28 males and 22 females (mean age: 55.7±2.3 years). The patients were randomly divided into two groups for thrombolysis with urokinase (400,000 U) and papaverine (30 mg) by either ophthalmic artery branch retrograde intervention (group A, n=26) or superselective ophthalmic artery/selective carotid intervention (group B, n=24). There was no significant difference in age (P=0.58), gender ratio (P=0.49), and time to onset (P=1.00) between the two groups. The adverse reactions and clinical efficacy were evaluated by postoperative DSA, fundus fluorescein angiography (FFA), and visual acuity tests.ResultsNo serious complications, abnormal eye movement, or vitreous hemorrhage occurred in either group. DSA showed that group A had an effective rate (92.30%) comparable to that of group B (100%, χ2=2.08, P=0.25). FFA suggested that both groups had similar treatment efficacy (χ2=3.09, P=0.21). Visual acuity tests also confirmed a similar efficacy of the two intervention approaches (χ2=0.25, P=0.88).ConclusionsThe developed novel ophthalmic artery branch retrograde intervention is highly effective and safe for CRAO, and may be a superior method compared with the conventional approach.

Central retinal artery occlusion after catheter ablation of atrial fibrillation

“…Common treatments for CRAO are shown in Table 3. 3,[10][11][12][13][14][15][16][17][18] Ocular massage was performed because the embolus in the central retinal artery was expected to be dislodged. 3 As medical therapies, vasodilators such as nitroglycerine and anticoagulant such as heparin have been used; however, there is no evidence that these agents are effective.…”

“…Heparin was reversed with protamine at the end of the procedure A recent study showed that digital subtraction angiographyguided superselective ophthalmic artery or selective carotid thrombolysis with urokinase and papaverine was an effective treatment method for CRAO. 12 Another study showed that alprostadil infusion resulted in significant visual improvement in patients with CRAO. 11 In this study, the logarithm of the minimum angle of resolution best-corrected visual acuity significantly improved from 2.73 to 1.48 at 1 month after the onset of CRAO, and all six patients experienced vision improvement.…”

Central retinal artery occlusion after catheter ablation of atrial fibrillation

“…Common treatments for CRAO are shown in Table 3. 3,[10][11][12][13][14][15][16][17][18] Ocular massage was performed because the embolus in the central retinal artery was expected to be dislodged. 3 As medical therapies, vasodilators such as nitroglycerine and anticoagulant such as heparin have been used; however, there is no evidence that these agents are effective.…”

“…A recent study showed that digital subtraction angiographyguided superselective ophthalmic artery or selective carotid thrombolysis with urokinase and papaverine was an effective treatment method for CRAO. 12 Another study showed that alprostadil infusion resulted in significant visual improvement in patients with CRAO. 11 In this study, the logarithm of the minimum angle of resolution best corrected visual acuity significantly improved from 2.73 to 1.48 at 1 month after the onset of CRAO, and all 6 patients experienced vision improvement.…”

Perdas visuais agudas: uma revisão dos últimos 10 anos de causas não infecciosas e não maculares

“…A oxigenioterapia hiperbárica imediata tem sido usada para fornecer oxigênio à retina isquêmica, a fim de manter a viabilidade, enquanto outras modalidades de tratamento são aplicadas para restaurar o fluxo sanguíneo da artéria central da retina. A angiografia por subtração digital (artéria oftálmica superseletiva guiada ou trombólise selectiva da carótida) continua a ser o método de tratamento preferido para a oclusão de artéria central da retina 14 .…”