Combined central retinal arterial and venous obstruction: emergency ophthalmic arterial fibrinolysis.
OBJECTIVE
To investigate the role of urokinase selectively perfused into the ophthalmic artery as an emergency treatment for combined central retinal arterial obstruction (CRAO) and central retinal venous obstruction (CRVO).


METHODS
Over a 6-year period, 11 consecutive patients presented with recent combined CRAO and CRVO (< or =72 hours). Urokinase (300,000 IU) was selectively perfused via the femoral artery into the ophthalmic artery for 40 minutes. Evaluation criteria were Snellen visual acuity with best correction, funduscopic results, and retinal arteriovenous transit time assessed over a mean 3.5-year follow-up. Mean vision and retinal perfusion were tested by means of repeated-measures analysis of variance. The correlation between visual improvement and retinal perfusion improvement was evaluated by means of Spearman rank correlation.


RESULTS
Substantial improvement in vision and retinal perfusion was noted in seven of the 11 patients treated. Mean vision improvement was significant (P =.009) within 24-48 hours after fibrinolysis, increased until 1 month after (P =.006), then remained stable throughout the follow-up (P >.10). Visual improvement correlated with retinal perfusion improvement during the period from before fibrinolysis to 24-48 hours after (P =.028). In all patients with improved results, retinal hemorrhages transiently increased. One patient had intravitreal hemorrhage shortly after fibrinolysis.


CONCLUSIONS
For this uncommon clinical entity, which typically has a poor visual outcome, these results suggest that ophthalmic arterial fibrinolysis may restore retinal perfusion, which leads to rapid substantial visual improvement in many cases of combined CRAO and CRVO, without systemic complications, but it may be responsible for intravitreal hemorrhage.
Vallée
Jean-Noël
JN
Department of Neuroradiology, Hôpital Lariboisière, University of Paris, France. jean-noel.vallee@psl.ap-hop-paris.fr
Paques
Michel
M
Aymard
Armand
A
Massin
Pascale
P
Santiago
Pierre-Yves
PY
Adeleine
Patrice
P
Gaudric
Alain
A
Merland
Jean-Jacques
JJ
D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D000792:Angiography; D001157:Arterial Occlusive Diseases / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D001783:Blood Flow Velocity; D003955:Diagnostic Tests, Routine; D004630:Emergencies; D005260:Female; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D009880:Ophthalmic Artery; D010960:Plasminogen Activators / Q000627:therapeutic use*; D012170:Retinal Vein Occlusion / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D018709:Statistics, Nonparametric; D015912:Thrombolytic Therapy / Q000379:methods*; D016896:Treatment Outcome; D014568:Urokinase-Type Plasminogen Activator / Q000627:therapeutic use*; D014792:Visual Acuity
D010960:Plasminogen Activators; D014568:Urokinase-Type Plasminogen Activator