Intra-arterial thrombolysis for acute central retinal artery occlusion

Zhang, X.; Ji, Xunming; Luo, Yumin; Liu, D.; Guo, Li; Wu, Heng; Miao, Zhongrong; Zhu, François; Li, Jiao; Ding, Yu; Li, Feng

doi:10.1179/174313209x444008

Cited by 15 publications

(8 citation statements)

References 15 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Two large reviews [52, 53] and several observational studies [31, 54, 55] have suggested that thrombolysis in the treatment of CRAO may improve the visual acuity with few serious complications. However, data from a large multicentre randomised study using intra-arterial thrombolysis [56••], and another randomised study using intravenous thrombolysis [30•] have failed to show an improvement in the visual acuity.…”

Section: Treatmentmentioning

confidence: 99%

Treatment Options for Central Retinal Artery Occlusion

Cugati

Varma

Chen

et al. 2012

Curr Treat Options Neurol

145

121

View full text Add to dashboard Cite

Opinion statementCentral retinal artery occlusion (CRAO) is an ocular emergency and is the ocular analogue of cerebral stroke. It results in profound, usually monocular vision loss, and is associated with significant functional morbidity. The risk factors for CRAO are the same atherosclerotic risk factors as for stroke and heart disease. As such, individuals with CRAO may be at risk of ischemic end organ damage such as a cerebral stroke. Therefore, the management of CRAO is not only to restore vision, but at the same time to manage risk factors that may lead to other vascular conditions. There are a number of therapies that has been used in the treatment of CRAO in the past. These include carbogen inhalation, acetazolamide infusion, ocular massage and paracentesis, as well as various vasodilators such as intravenous glyceryl trinitrate. None of these “standard agents” have been shown to alter the natural history of disease definitively. There has been recent interest shown in the use of thrombolytic therapy, delivered either intravenously or intra-arterially by direct catheterisation of the ophthalmic artery. Whilst a number of observational series have shown that the recovery of vision can be quite dramatic, two recent randomised controlled trials have not demonstrated efficacy. On the contrary, intra-arterial delivery of thrombolytic may result in an increased risk of intracranial and systemic haemorrhage, while the intravenous use of tissue plasminogen activator (tPA) was not shown to be efficacious within 24 h of symptom onset. Nevertheless, both of these studies have shown one thing in common, and that is for treatment to be effective in CRAO, it must be deployed within a short time window, probably within 6 h of symptom onset. Therefore, while CRAO is a disease that does not have a treatment, nevertheless it needs to follow the same principles of treatment as any other vascular end organ ischaemic disease. That is, to attempt to reperfuse ischemic tissue as quickly as possible and to institute secondary prevention early.

show abstract

Section: Treatmentmentioning

confidence: 99%

Treatment Options for Central Retinal Artery Occlusion

Cugati

Varma

Chen

et al. 2012

Curr Treat Options Neurol

145

121

View full text Add to dashboard Cite

show abstract

“…Hence, there is no consistent conclusion on the tolerance time of retinal ischemia in humans, which need further study. In our previous study and other respective case series and cohort studies, it was concluded that IAT could improve visual function in patients with acute CRAO within 6 hours of symptom onset (9,14–16). This study further confirmed that IAT may partially improve visual acuity within 16 h of symptom onset, which may be associated with incomplete ARI having a certain percentage.…”

Section: Discussionmentioning

confidence: 94%

Intra-arterial Thrombolysis for Acute Retinal Ischemia: A Retrospective, Observational, Cohort Study

Gao¹,

Zhao²,

Wu³

et al. 2022

Journal of Neuro-Ophthalmology

View full text Add to dashboard Cite

Background:To determine whether intra-arterial thrombolysis (IAT) within 16 hours after the onset of symptoms is feasible and associated with better visual outcomes in patients with acute retinal ischemia (ARI).Methods:The retrospective cohort study was performed from January 2014 to December 2021 in the Xuanwu Hospital of Capital Medical University. Patients with ARI who initially presented visual acuity of 20/100 or worse were screened in the study. Visual end points were evaluated at one week and at final visit after treatment. Serious adverse events were recorded during operation and within 1 week after IAT treatment.Results:The amount of clinically significant visual improvement (≥0.3 logarithm of the minimum angle of resolution) in the IAT group was significantly higher than that in the conservative treatment group at one week after the treatment (47.8% vs 16.7%; P = 0.014) and at final visit (52.2% vs 20%; P = 0.014). After controlling confounding factors, ARI treatment was the only factor significantly associated with the amount of clinically significant visual improvement (OR, 4.364; 95 CI, 1.298–14.667; P = 0.017). A patient (4.3%) experienced retinal hemorrhage without symptom within 1 week after IAT treatment. No patients experienced new symptomatic cerebral infarction, intracranial hemorrhage, TIA, artery dissection, vascular perforation, and distal embolization during operation and within 1 week after IAT treatment.Conclusions:IAT may be associated with better visual improvement within 16 hours after the onset of symptoms. Besides, IAT is feasible and associated with a low risk of periprocedural complications for ARI. This study will aid in feasibility testing and sample size calculations in advance of future, fully-powered efficacy studies for ARI.

show abstract

“…No control group. Small sample sizeZhang et al57, 200949<6Urokinase 626,000 units mean dose. Systemic heparin during procedure.…”

Section: Resultsmentioning

confidence: 99%

<p>Intra-Arterial Thrombolysis for Central Retinal Artery Occlusion</p>

Hakim¹,

Hakim²

2019

OPTH

View full text Add to dashboard Cite

IntroductionCentral retinal artery occlusion is an ophthalmic emergency which typically causes acute, painless visual loss. Several conservative treatment options are practiced with little benefit. Thrombolysis as a therapeutic option has gathered interest as well as controversy. This paper aims at reviewing the relevant literature to assess the efficacy and safety of intra-arterial thrombolysis for acute central retinal artery occlusion.MethodsA review of the literature was conducted. Keywords included “intra-arterial thrombolysis” or “intra-arterial fibrinolysis” in combination with “central retinal artery occlusion” or “CRAO”. A Cochrane Database search was performed for randomised control trials, systematic reviews and meta-analyses using the same keywords.ResultsTwenty-eight studies were identified which included case reports, case series, case-control studies and 1 randomised control trial: the European Assessment Group for Lysis in the Eye Study. Improvement in vision was measured using different methods and at different time points. The findings of these studies generally favour an effect towards intra-arterial thrombolysis however there are many limitations. Additionally, the European Assessment Group for Lysis in the Eye Study showed lack of effect in intra-arterial thrombolysis vs conservative measures.ConclusionCurrent evidence is not sufficient to recommend intra-arterial thrombolysis due to the variability of visual improvement within retrospective studies, heterogeneity in treatment regimens between studies and adverse effects. Intra-arterial thrombolysis may have a role in patients presenting early, particularly if they have monocular vision, after discussion of the risks and benefits. Further high-quality trials assessing the clinical efficacy of intra-arterial thrombolysis may shed more light on this topic.

show abstract

Intra-arterial thrombolysis for acute central retinal artery occlusion

Abstract: Intra-arterial thrombolysis could obviously improve the short- and long-term visual function for patients with acute central retinal artery occlusion within 6 hours of symptom onset.

Cited by 15 publications

References 15 publications

Treatment Options for Central Retinal Artery Occlusion

Treatment Options for Central Retinal Artery Occlusion

Intra-arterial Thrombolysis for Acute Retinal Ischemia: A Retrospective, Observational, Cohort Study

<p>Intra-Arterial Thrombolysis for Central Retinal Artery Occlusion</p>

Contact Info

Product

Resources

About