Retinal Infarction: A Pilot Study on the Efficacy and Safety of Intravenous Thrombolysis and Underlying Aetiologies

Abstract

Background: Treatment of non-arteritic central retinal artery occlusion is still inconsistent. Therefore, the current study aimed to evaluate the efficacy of intravenous thrombolysis (IVT) and describe the prevalence of co-occurring ischemic brain lesions in patients with acute visual loss due to ischemia. Methods: We analysed 38 consecutive patients with acute visual loss between January 2015 and June 2020. Patients presenting within 4.5 h of symptom onset without any contraindication were treated with IVT. Patients underwent neurologic and ophthalmologic examination and diagnostic workup for the underlying aetiology. Follow-up was performed after 3 and 12 months. Results: Patients treated with IVT had a significantly better functional outcome at discharge compared to patients treated conservatively. No additional ischemic brain lesions were detected (0 of 38). Three patients had extracranial carotid artery stenosis ≥50%. Atrial fibrillation was present in four patients, three of whom already received oral anticoagulation. In the remaining 31 patients no embolic source was detected. However, the number of plaques were rated mild to moderate. Within three months, one patient developed transient visual loss while another suffered a contralateral transient ischemic attack. Conclusions: IVT may represent a safe and effective treatment option in patients with isolated visual loss due to ischemia. The aetiology was atherosclerotic burden rather than embolism caused by carotid stenosis or atrial fibrillation, bringing the current diagnostic procedure and therapy into question. Randomized trials are necessary to evaluate the efficacy and safety of IV thrombolysis and clarify the aetiology of isolated visual loss due to ischemia.

Thrombolysis for central retinal artery occlusion: An individual participant-level meta-analysis

“…Although our study was attempted to be inclusive and explore multiple influential factors on the outcome of naCRAO patients, we could not control for all variability among studies such as degree of carotid stenosis and additional ischemic cerebral changes. 22,52,58,76 –78 In addition, the detail of heparin 56,77 and antiplatelet therapy varies among the studies and limits the conclusion about timing and the appropriate regiment of antiplatelets after thrombolysis.…”

Diffusion-weighted magnetic resonance imaging in early central retinal artery occlusion

“… 16 However, intravenous tissue-type plasminogen activator treatment (rtPA) has emerged as a potential therapy for CRAO patients, but the potential treatment effect is limited to a narrow therapeutic window of up to 4.5 h after onset. 2 , 17 , 18 Currently, three European randomized-controlled trials investigate the efficacy of intravenous tissue-type plasminogen activator treatment in CRAO (NCT04965038, NCT03197194, NCT04526951). In the context of a time-dependent treatment efficacy in CRAO, reliable early diagnosis of the disease is becoming increasingly important.…”

Intravenous Thrombolysis for Central Retinal Artery Occlusion: A Look at the Literature for the Emergency Medicine Physician

“…All other patients received standard-of-care treatment. Results demonstrated that the IVT group had a more significant difference between the modified Rankin scale at admission and discharge than the standard-of-care groups [27]. A single patient (11.1%) in the IVT group developed an asymptomatic ICH [27].…”

“…Schönecker et al published a pilot study in 2022 investigating the efficacy and safety of IVT in patients with retinal infarction [27]. They enrolled 38 patients, 19 with CRAO, six with branch retinal artery occlusion (BRAO), and 13 with transient vision loss (TVL).…”

“…They enrolled 38 patients, 19 with CRAO, six with branch retinal artery occlusion (BRAO), and 13 with transient vision loss (TVL). Of the 19 patients with CRAO, nine were treated with IVT [27]. All other patients received standard-of-care treatment.…”