title: Efficacy of intravenous tissue-type plasminogen activator in central retinal artery occlusion: report from a randomized, controlled trial.
abstract: OBJECTIVE
  Central retinal artery occlusion is caused by a platelet-fibrin thrombus or embolic occlusion and is a stroke of the eye. Observational studies suggest that thrombolytics may restore ocular perfusion and visual function. We hypothesized that intravenous tissue-type plasminogen activator (tPA) administered within 24 hours of symptom onset might restore ocular perfusion and visual function.
  
  
  METHODS
  A placebo-controlled, randomized trial of intravenous tPA versus intravenous saline was performed in patients with clinically defined central retinal artery occlusion within 24 hours of symptom onset. tPA was administered at a total dose of 0.9 mg/kg, with 10% given as a 1-minute bolus and the remainder over 1 hour. An improvement of visual acuity of 3 lines or more was considered significant.
  
  
  RESULTS
  Twenty-five percent (2 of 8) of the tPA group experienced the primary outcome at 1 week after tPA versus none of the placebo group. One patient had an intracranial hemorrhage. The visual acuity improvement of these 2 patients was not sustained at 6 months. In both patients, tPA was administered within 6 hours of symptom onset.
  
  
  CONCLUSIONS
  Although essentially a negative study, it does add to the evidence base of reperfusion in central retinal artery occlusion by showing that the time window for intervention is likely to be <6 hours. Reocclusion is a potential problem and may require adjuvant anticoagulation. Future studies should concentrate on determining the efficacy of thrombolytics in the <6-hour time window. Clinical Trial Registration- URL: http://www.anzctr.org.au. Unique identifier: 83102.
authors.affiliation: Department of Ophthalmology, Flinders Comprehensive Stroke Centre, Flinders Medical Centre and University, Bedford Park, Australia.
authors.forename: Celia S
authors.initials: CS
authors.lastname: Chen
authors.forename: Andrew W
authors.initials: AW
authors.lastname: Lee
authors.forename: Bruce
authors.initials: B
authors.lastname: Campbell
authors.forename: Tien
authors.initials: T
authors.lastname: Lee
authors.forename: Mark
authors.initials: M
authors.lastname: Paine
authors.forename: Clare
authors.initials: C
authors.lastname: Fraser
authors.forename: John
authors.initials: J
authors.lastname: Grigg
authors.forename: Romesh
authors.initials: R
authors.lastname: Markus
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015356:Retinal Artery Occlusion / Q000188:drug therapy*; D015912:Thrombolytic Therapy; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator