Superselective ophthalmic arterial fibrinolysis with urokinase for recent severe central retinal venous occlusion: initial experience.
OBJECTIVE
To investigate the effects of local ophthalmic arterial fibrinolysis on central retinal venous occlusion (CRVO).


METHODS
Thirteen patients had recent severe nonischemic CRVO for which no alternative therapy was available. A flow-guide microcatheter was introduced coaxially via the femoral artery into the ophthalmic arterial ostium, and urokinase was perfused for 40 minutes. Vision, funduscopic findings, and retinal perfusion were assessed during 1 year of follow-up.


RESULTS
Five of the 13 patients treated experienced visual improvement (P =.05) and retinal perfusion within 24-48 hours. Vision returned to normal within 24-48 hours in three patients, within 1 week in one patient, and within 1 month in one patient. These five patients exhibited progressive lesion regression within 2-4 weeks at funduscopy. Their clinical course prior to treatment resembled that of combined central retinal arterial occlusion (CRAO) and CRVO, which typically has a poor visual outcome. One patient relapsed 1 month after fibrinolysis. Of the remaining eight patients, one had normal vision at 12 months, and seven had no improvement. No technical complications were observed.


CONCLUSIONS
Although there was no control group, the short period between fibrinolysis and substantial visual improvement, combined with marked retinal perfusion improvement, suggests that fibrinolysis is beneficial for CRVO, especially for recent CRAO and CRVO.
Vallée
J N
JN
Departments of Neuroradiology and Therapeutic Angiography, Hôpital Lariboisière, Paris, France.
Massin
P
P
Aymard
A
A
Paques
M
M
Herbreteau
D
D
Santiago
P Y
PY
Losser
M R
MR
Gaudric
A
A
Merland
J J
JJ
D000328:Adult; D000368:Aged; D005260:Female; D005451:Fluorescein Angiography; D006801:Humans; D007261:Infusions, Intra-Arterial; D008297:Male; D008875:Middle Aged; D009880:Ophthalmic Artery / Q000000981:diagnostic imaging; D010865:Pilot Projects; D010960:Plasminogen Activators / Q000008:administration & dosage*; D011446:Prospective Studies; D015641:Radiography, Interventional; D012170:Retinal Vein Occlusion / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000503:physiopathology; D015912:Thrombolytic Therapy; D014568:Urokinase-Type Plasminogen Activator / Q000008:administration & dosage*; D014792:Visual Acuity
D010960:Plasminogen Activators; D014568:Urokinase-Type Plasminogen Activator