Selective intra-arterial fibrinolysis of acute central retinal artery occlusion.
OBJECTIVE
Occlusion of the central retinal artery (CRAO) causes a sudden decrease of monocular vision. Because early restoration of blood flow may improve outcome, we attempted to treat CRAO with selective intra-arterial fibrinolysis.


METHODS
Intra-arterial fibrinolysis was performed within 6 hours after symptom onset in 17 patients with thromboembolic CRAO. Symptoms were painless, acute and severe decrease of vision. Urokinase (100 000 to 900 000 IU) was given through a microcatheter into the ophthalmic artery over 10 to 90 minutes. For comparison, the history and visual outcome of 15 control patients who did not receive fibrinolytics were evaluated. In both groups some of the patients underwent paracentesis and/or received carboanhydrase inhibitors.


RESULTS
Patients who underwent fibrinolysis fared better than control patients (P=0.01). Three patients (17.6%) recovered completely after fibrinolysis and regained visual acuity of 20/20 (n=2) to 25/20 (n=1). Two additional patients (11.8%) showed a marked improvement to a visual acuity of 20/30. In 6 patients (35. 3%) vision improved slightly. They were able to count fingers, detect hand movements, or perceive light. In 6 patients (35.3%), fibrinolytic treatment was without effect. Among control patients, 1 patient (6.7%) showed partial, 4 patients (26.7%) minimal, and 10 (66.7%) no improvement of vision.


CONCLUSIONS
A complete or marked improvement of visual acuity was achieved in one third of intra-arterial fibrinolysis patients but in none of the control patients. Intra-arterial fibrinolysis seems to have the potential to "lighten" the spontaneously poor outcome of CRAO.
Departments of Neuroradiology and Neurology, University of Bern, Bern, Switzerland.
J
J
Weber
L
L
Remonda
H P
HP
Mattle
U
U
Koerner
R W
RW
Baumgartner
M
M
Sturzenegger
C
C
Ozdoba
F
F
Koerner
G
G
Schroth
D000208:Acute Disease; D000368:Aged; D002257:Carbonic Anhydrase Inhibitors / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007269:Injections, Intra-Arterial; D008297:Male; D008875:Middle Aged; D009880:Ophthalmic Artery; D019152:Paracentesis; D010960:Plasminogen Activators / Q000627:therapeutic use*; D015356:Retinal Artery Occlusion / Q000188:drug therapy* / Q000503:physiopathology; D012189:Retrospective Studies; D013923:Thromboembolism / Q000188:drug therapy* / Q000503:physiopathology; D015912:Thrombolytic Therapy; D016896:Treatment Outcome; D014568:Urokinase-Type Plasminogen Activator / Q000627:therapeutic use*; D014792:Visual Acuity / Q000187:drug effects / Q000502:physiology
D002257:Carbonic Anhydrase Inhibitors; D010960:Plasminogen Activators; D014568:Urokinase-Type Plasminogen Activator