Interest of local intra-arterial fibrinolysis in acute central retinal artery occlusion: Clinical experience in 16 patients

Mercier, Jean; Kastler, Adrian; Souteyrand, Georges; Chabert, Emmanuel; Claise, Béatrice; Pereira, Bruno; Gabrillargues, Jean

doi:10.1016/j.neurad.2014.02.007

Cited by 17 publications

(11 citation statements)

References 24 publications

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“…Unfortunately, a reliable improvement in visual function has not been demonstrated in patients treated with thrombolytics following acute retinal ischemia (89,90); no significant improvement in visual function following administration of tPA was reported in a number of retrospective reviews and observational studies (91–93), however other observational studies, case reports, and retrospective reviews have suggested that visual function improved following administration of tPA (94–101). It is possible that the low rate of vision improvement reported in most studies is related to the time between onset of visual symptoms and the administration of thrombolytics (72,96,101–105); in most studies, thrombolytics were administered more than 12 hours after vision loss. However, a recent study examining the data from five retrospective case series of patients diagnosed with CRAO and treated with either urokinase (45 patients) or tPA (73 patients) failed to find a relationship between improvement in visual function and the time from onset of visual symptoms to treatment (106).…”

Section: Treatment Of Acute Retinal Ischemia (Crao or Brao)mentioning

confidence: 99%

Acute retinal arterial ischemia

Dattilo¹,

Newman²,

Biousse³

2018

Ann. Eye Sci

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Acute retinal arterial ischemia, which includes transient monocular vision loss (TMVL), branch retinal artery occlusion (BRAO), central retinal artery occlusion (CRAO) and ophthalmic artery occlusion (OAO), is most commonly the consequence of an embolic phenomenon from the ipsilateral carotid artery, heart or aortic arch, leading to partial or complete occlusion of the central retinal artery (CRA) or its branches. Acute retinal arterial ischemia is the ocular equivalent of acute cerebral ischemia and is an ophthalmic and medical emergency. Patients with acute retinal arterial ischemia are at a high risk of having further vascular events, such as subsequent strokes and myocardial infarctions (MIs). Therefore, prompt diagnosis and urgent referral to appropriate specialists and centers is necessary for further work-up (such as brain magnetic resonance imaging with diffusion weighted imaging, vascular imaging, and cardiac monitoring and imaging) and potential treatment of an urgent etiology (e.g., carotid dissection or critical carotid artery stenosis). Since there are no proven, effective treatments to improve visual outcome following permanent retinal arterial ischemia (central or branch retinal artery occlusion), treatment must focus on secondary prevention measures to decrease the likelihood of subsequent ischemic events.

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Section: Treatment Of Acute Retinal Ischemia (Crao or Brao)mentioning

confidence: 99%

Acute retinal arterial ischemia

Dattilo¹,

Newman²,

Biousse³

2018

Ann. Eye Sci

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“…Seventy-six articles were identified as being relevant to our topic. Twenty-one relevant studies were included as they were containing five or more patients treated with IAT for acute non-arteritic CRAO ( 14 – 25 , 29 – 34 ). Of these, nine were excluded either for not being written in English, representing duplicate data, or both.…”

Section: Resultsmentioning

confidence: 99%

“…In total, 12 English language studies were identified as being relevant to the topic of discussion and satisfying all criteria for review. Eleven of these studies were retrospective in nature and one was a randomized controlled trial ( 14 – 25 ). A total of 417 patients treated with IAT are presented.…”

Section: Resultsmentioning

confidence: 99%

Intra-Arterial Thrombolysis for Acute Central Retinal Artery Occlusion: A Systematic Review and Meta-Analysis

et al. 2018

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Background and purposeAcute central retinal artery occlusion (CRAO) is a serious ophthalmologic emergency that may result in monocular blindness. To date, studies evaluating intra-arterial thrombolysis (IAT) have not shown a definitive clinical benefit. We have conducted a systematic review with a meta-analysis to effectively evaluate this treatment option.MethodsA systematic literature search was focused on studies containing five or more patients undergoing IAT that included a control group treated with standard therapy. Pooled meta-analysis was performed.ResultsFive retrospective controlled studies and one randomized clinical trial were identified satisfying all inclusion criteria resulting in the analysis of 236 patients treated with IAT and 255 patients treated with ST. A pooled fixed effects analysis resulted in an estimated odds ratio of 2.52, 95% CI (1.69, 3.77) (P < 0.0001) favoring IAT.ConclusionIAT is a promising therapeutic option for CRAO with great potential. Further randomized trials are needed to establish a significant benefit and ensure the safety of the intervention.

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“…The study publication dates ranged from 1992 to 2013 and subject level data were obtained for 118 patients (table 1) [10,11,12,13,14]. Another study conducted by Framme et al [15] was also identified; however, due to a language barrier, it was omitted from this study.…”

Section: Resultsmentioning

confidence: 99%

“…Values for profoundly low visual acuity scores were subsequently converted to a logMAR scale in accordance with the technique described by Lange et al [9]. Mercier et al [10] included a profoundly low visual acuity choice of ‘see steady hand' that was not quantified by Lange et al A logMAR score equal to 2.13 was chosen to quantify this option as it represented a profoundly low visual acuity ranging between counting fingers (logMAR = 1.98) and hand movement (logMAR = 2.28).…”

Section: Methodsmentioning

confidence: 99%

Visual Improvement after Intra-Arterial Thrombolysis for Central Retinal Artery Occlusion Does Not Correlate with Time to Treatment

2016

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Background: Intra-arterial thrombolysis (IAT) for the treatment of acute central retinal artery occlusion (CRAO) has demonstrated variable results for improving visual acuity and remains controversial. Despite limited evidence, time from symptom onset to thrombolysis is believed to be an important factor in predicting visual improvement after IAT. Methods: A comprehensive review of the literature was conducted and individual subject level data were extracted from relevant studies. From these, a secondary analysis was performed. Initial and final logarithm of the minimum angle of resolution (logMAR) scores were either abstracted directly from relevant studies or converted from provided Snellen chart scores. Change in logMAR scores was used to determine overall treatment efficacy. Results: Data on 118 patients undergoing IAT from five studies were evaluated. Median logMAR improvement in visual acuity was -0.400 (p < 0.001). There was no significant association between logMAR change and time to treatment when time (hours) was described as a continuous variable or described categorically [0-4, 4-8, 8-12, 12+ h; or 0-6, 6-12, 12+ h]. Conclusion: The visual improvement observed in this series had no relationship to the time from symptom onset to treatment with IAT. This suggests that patients may have the possibility for improvement even with delayed presentation to the neurointerventionalist. Other factors, such as completeness of retinal occlusion, may be more important than time to treatment. Additional studies to determine optimal patient selection criteria for the endovascular treatment of acute CRAO are needed.

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Interest of local intra-arterial fibrinolysis in acute central retinal artery occlusion: Clinical experience in 16 patients

Cited by 17 publications

References 24 publications

Acute retinal arterial ischemia

Acute retinal arterial ischemia

Intra-Arterial Thrombolysis for Acute Central Retinal Artery Occlusion: A Systematic Review and Meta-Analysis

Visual Improvement after Intra-Arterial Thrombolysis for Central Retinal Artery Occlusion Does Not Correlate with Time to Treatment

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