Systemic Prostaglandin E1 to Treat Acute Central Retinal Artery Occlusion

Abstract

Citation: Takai Y, Tanito M, Matsuoka Y, Hara K, Ohira A. Systemic prostaglandin E1 to treat acute central retinal artery occlusion. Invest Ophthalmol Vis Sci. 2013;54:3065-3071. DOI:10.1167/iovs.12-11445 PURPOSE. To report the efficacy of systemic prostaglandin E1 (PGE1) monotherapy for treating acute central retinal artery occlusion (CRAO).METHODS. The best-corrected visual acuity (BCVA) and side effects were evaluated retrospectively in 10 consecutive eyes (nine patients; mean age, 61.3 years) with acute CRAO treated with PGE1 monotherapy. The protocol included intravenous injection of 40 lg PGE1 twice daily (80 lg per day) for 5 days then oral PGE1 three times daily (30 lg per day) for at least 1 month. In four eyes, the retinal vessel diameters were assessed on serial fundus photographs. RESULTS.The mean time to treatment was 7.1 hours (range, 1-18 hours). The mean 6 SD logarithm of the minimum angle of resolution (logMAR) BCVAs at baseline and 1 month after initiation of therapy were 2.67 6 0.54 (range, 3.00-1.70) and 0.52 6 0.62 (range, 2.00 to À0.18), respectively (P ¼ 0.005); the BCVA improved by 1.0 or more logMAR unit at 1 month in all eyes. The BCVA improvement was correlated negatively with the time to treatment (q ¼ À0.655, P ¼ 0.0492), but was not correlated with age (q ¼ À0.473, P ¼ 0.156) and did not differ between sexes (P ¼ 0.0871). Compared with baseline, the mean changes in the vessel diameters in four cases were 151.1% (range, 115.1%-188.0%) in the arteries and 191.0% (range, 127.2%-246.4%) in the veins 1 day after initiation of therapy. Angialgia during injection was the only side effect.CONCLUSIONS. Systemic administration of PGE1 for acute CRAO rapidly restores retinal blood flow by its vasodilatory effects, improves VA, is well tolerated with few side effects, and requires no special training.

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.…”

Periarteriolar-Sparing Retinal Edema in Acute Central Retinal Artery Occlusion

“…Accordingly, we propose that differences in oxygen saturation resulting in differences in the distances from the arterioles may explain the alternating pattern of retinal edema in incomplete CRAO. PGE1 administered systemically can improve the visual acuity if it is administered during the acute phase, i.e., typically within 1 day after the onset of acute CRAO [ 2 , 8 ]. The visual acuity in the current case recovered after administration of systemic PGE1 2 days after onset.…”

“…1d ) showed that the hyperreflectivity coincided with the retinal opacification around the venules and the lower reflectivity coincided with the nonedematous retinal tissue around the arterioles. Based on the pattern of onset and fundus findings, we diagnosed incomplete acute CRAO OD and immediately started a venous drip injection of prostaglandin E1 (PGE1) [ 2 ]. Fluorescein angiography performed after the initial PGE1 drip showed an arm-to-retina circulatory time of 28 s and an early-phase filling defect in the small capillary networks in the macular region (fig.…”

“…Doppler echocardiography did not show arterial narrowing or endothelial plaque in either carotid artery. According to a reported protocol [ 2 ], the patient was treated with intravenous PGE1 (80 µg/day) for 5 days and then oral PGE1 (30 µg/day) for 1 month. One month after onset, the BCVA improved to 0.5 OD and the striated retinal edema and most cotton-wool patches resolved (fig.…”

Intravenous lipo-prostaglandin E1 administration for patients with acute central retinal artery occlusion

“…Prostaglandin E1 (PGE1) is known to dilate blood vessels and inhibit platelet aggregation to increase blood flow 20 21. In previous reports, CRAO eyes showed better visual outcomes after PGE1 treatment (using a dosage of 80 µg/day) than that before PGE1 treatment,22 23 suggesting that PGE1 treatment is an option for treatment of CRAO. However, fatal side effects, such as cerebral haemorrhage, have been reported with high-dose PGE1 therapy 24…”