Selective thrombolysis of central retinal artery occlusion without long-term systemic heparinization.
BACKGROUND
A central retinal artery occlusion is a potentially blinding retinal vascular event with no effective treatment regimen available. Recently, a few reports have described improved vision in eyes with central retinal artery occlusions after selective fibrinolytic therapy followed by long-term systemic anticoagulation. Acceptance of this treatment, however, has been hampered by a paucity of confirmatory reports and its potential for producing serious hemorrhagic complications. Our report independently confirms the beneficial effects of selective thrombolysis, even with the use of only short-term, post-procedure systemic heparinization.


METHODS
A case report of selective fibrinolysis of an occluded central retinal artery using urokinase infusion into the ophthalmic artery followed with only 12 h of systemic heparinization is described.


RESULTS
A 65-year-old man presenting with a central retinal artery occlusion of less than 4-h duration enjoyed an improvement of vision from counting-fingers acuity to 20/20 after selective fibrinolysis with urokinase and only 12 h of systemic heparinization. No hemorrhagic or thrombotic complications occurred.


CONCLUSIONS
Selective thrombolysis with urokinase followed by short-term systemic heparinization can effectively treat a central retinal artery occlusion. Whereas the authors acknowledge that a single case does not prove that short-term heparinization is better than long-term heparinization, it does show that the latter is not always required.
Wirostko
W J
WJ
The Eye Institute, Medical College of Wisconsin, Milwaukee 53226-4812, USA.
Pulido
J S
JS
Hendrix
L E
LE
D000368:Aged; D000792:Angiography / Q000379:methods; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006493:Heparin / Q000627:therapeutic use*; D006801:Humans; D007261:Infusions, Intra-Arterial; D008297:Male; D009880:Ophthalmic Artery / Q000000981:diagnostic imaging; D015356:Retinal Artery Occlusion / Q000000981:diagnostic imaging / Q000188:drug therapy*; D015912:Thrombolytic Therapy / Q000379:methods*; D013997:Time Factors; D016896:Treatment Outcome; D014568:Urokinase-Type Plasminogen Activator / Q000627:therapeutic use
D005343:Fibrinolytic Agents; D006493:Heparin; D014568:Urokinase-Type Plasminogen Activator