Selective intraarterial fibrinolysis of acute central retinal artery occlusion.
OBJECTIVE
To evaluate the outcome of our patients with central retinal artery occlusion after local fibrinolysis and to compare these data with results reported in the literature.


METHODS
Over a period of 7 years, 22 patients (11 male, 11 female, mean age 64.6 +/- 12.1 years) were treated with super-selective local fibrinolysis. In 1 case, treatment was carried out via the maxillary-ophthalmic anastomoses due to preexisting occlusion of the ipsilateral internal carotid artery. The latency period from the onset of symptoms to the beginning of therapy was 7.6 +/- 1.8 h. Urokinase was used in 7 cases (300,000-1.1 million units) and recombinant tissue plasminogen activator (20-40 mg) was applied in 15 patients. Visual acuity and fundus were examined before and after treatment.


RESULTS
One patient (1/22 = 4.6%) recovered completely and regained a visual acuity of 20/20. Six patients (6/22 = 27.3%) showed a marked improvement with a range of visual outcome from 20/800 to 20/320. In 2 cases (2/22 = 9.1%) only a slight improvement was observed, with a visual outcome allowing detection of hand movements. In 13 cases (13/22 = 59.1%) no change in visual acuity as a result of treatment was observed. In 2/22 cases (9.2%) reversible neurological side-effects occurred, in 1 case suffered a stroke, and in another case intracerebral bleeding was observed.


CONCLUSIONS
In our study, the recovery of visual acuity and the complication rate were not as positive as reported in the literature.
Butz
B
B
Department of Radiology, University of Regensburg Hospital, Regensburg, Germany. bebu0000@t-online.de
Strotzer
M
M
Manke
C
C
Roider
J
J
Link
J
J
Lenhart
M
M
D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage; D006801:Humans; D007269:Injections, Intra-Arterial; D008297:Male; D008875:Middle Aged; D009880:Ophthalmic Artery; D011994:Recombinant Proteins / Q000008:administration & dosage; D015356:Retinal Artery Occlusion / Q000188:drug therapy* / Q000503:physiopathology; D012189:Retrospective Studies; D015912:Thrombolytic Therapy / Q000379:methods*; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage; D016896:Treatment Outcome; D014568:Urokinase-Type Plasminogen Activator / Q000008:administration & dosage; D014792:Visual Acuity
D005343:Fibrinolytic Agents; D011994:Recombinant Proteins; D010959:Tissue Plasminogen Activator; D014568:Urokinase-Type Plasminogen Activator