Local intra-arterial fibrinolysis for acute occlusion of the central retinal artery: a meta-analysis of the published data.
OBJECTIVE
Central retinal artery occlusion (CRAO) is typically associated with a poor visual outcome. Several favourable reports of local intra-arterial fibrinolysis (LIF), which involves the superselective administration of a thrombolytic agent directly into the ophthalmic artery, have appeared in the recent literature. The aim of this study was to critically appraise these studies in a collective fashion.


METHODS
A meta-analysis was performed of all the published literature germane to LIF in cases of CRAO.


RESULTS
Of the 16 studies identified, all were retrospective and non-randomised. After correction for data duplication, the results of LIF in 100 patients can be reported. A final acuity of 6/6 or better was seen in 14% of patients following LIF, and a visual result of 6/12 or better was seen in 27% of subjects. A poor final acuity of 3/60 or worse was seen in 60.6% of eyes treated with local intra-arterial fibrinolysis. These results compare favourably with conventional forms of therapy. Potentially serious complications were seen in four patients, but no patient suffered a permanent neurological deficit.


CONCLUSIONS
The results of this study suggest that there may be a marginal visual benefit associated with LIF compared with conventional management of CRAO. However, the methodology of the cited studies was often unsatisfactory, and a randomised controlled trial of LIF in cases of CRAO is justified. Outside of a randomised clinical trial, the use of superselective fibrinolytic therapy for CRAO cannot be recommended on the basis of current evidence.
Beatty
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Academic Department of Ophthalmology, Manchester Royal Eye Hospital. stephen@stiofanbetagh.demon.co.uk
Au Eong
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D000208:Acute Disease; D005343:Fibrinolytic Agents / Q000008:administration & dosage*; D006801:Humans; D007261:Infusions, Intra-Arterial; D007269:Injections, Intra-Arterial; D015356:Retinal Artery Occlusion / Q000188:drug therapy* / Q000503:physiopathology; D015912:Thrombolytic Therapy / Q000379:methods*; D016896:Treatment Outcome; D014792:Visual Acuity / Q000502:physiology
D005343:Fibrinolytic Agents