Intra-arterial fibrinolytic therapy in central retinal artery occlusion.
We have treated 23 patients with central retinal artery occlusion by intra-arterial fibrinolysis, a method already in use for treatment of thromboembolic occlusion of the cerebral arteries. Fibrinolysis was carried out through a microcatheter placed in the origin of the ophthalmic artery. When ophthalmic artery cannot be catheterised, treatment can be carried out indirectly via the maxillary-ophthalmic anastomoses. In 18 cases urokinase was used in doses of 200,000-1,200,000 units; in 5 patients recombinant tissue plasminogen activator was used. Six patients showed marked improvement or total recovery, and six partial recovery, with improvement of visual acuity or a field defect. The worst results were obtained in six patients where the mean delay between the appearance of symptoms and initiation of treatment was more than 20 h. Intra-arterial thrombolysis led to a better outcome in acute occlusion of the central retinal artery than might have been expected with conservative treatment. A good prognosis is to be expected when treatment starts within the first 6-8 h, when some vision remains and when there is less retinal oedema.
Schumacher
M
M
Department of Neuroradiology, University of Freiburg, Germany.
Schmidt
D
D
Wakhloo
A K
AK
D000368:Aged; D000369:Aged, 80 and over; D002406:Catheterization, Peripheral; D005260:Female; D005451:Fluorescein Angiography; D006801:Humans; D007261:Infusions, Intra-Arterial; D008297:Male; D008875:Middle Aged; D009880:Ophthalmic Artery; D015642:Radiology, Interventional; D015356:Retinal Artery Occlusion / Q000175:diagnosis / Q000188:drug therapy*; D015912:Thrombolytic Therapy / Q000379:methods*; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage / Q000627:therapeutic use; D014568:Urokinase-Type Plasminogen Activator / Q000008:administration & dosage* / Q000627:therapeutic use
D010959:Tissue Plasminogen Activator; D014568:Urokinase-Type Plasminogen Activator