title: Acute central retinal artery occlusion treated with intravenous recombinant tissue plasminogen activator.
abstract: Central retinal artery occlusion (CRAO) causes ischemic stroke of the eye. We report a case of CRAO that was successfully treated with intravenous recombinant tissue plasminogen activator (rt-PA) and review the current literature. A 64-year-old right-handed man presented to the emergency department with acute left eye amaurosis. An ophthalmologic assessment revealed a left afferent pupillary defect, minimal visual acuity, macular edema with a cherry red spot, and multiple emboli in the inferotemporal arcade of the left eye. A neurologic examination was otherwise nonfocal; neuroimaging was normal. Acute CRAO was diagnosed, and rt-PA was administered intravenously 185 minutes after symptom onset. A repeat examination 4.5 hours after treatment found improved vision, reduced macular edema, and no emboli. An ophthalmologic evaluation 10 days later found a visual acuity of 20/200 in the left eye and bilateral arterial sclerosis without evidence of retinal emboli or macular edema. This case illustrates that intravenous rt-PA may be an effective therapeutic option for CRAO in select patients. Given the current literature and the recommended established safety window for thrombolytics in acute ischemic cerebral stroke, it is reasonable to administer intravenous treatment for CRAO within 4.5 hours after symptom onset. Nevertheless, it is critical that a prospective clinical trial confirm the efficacy, safety, and time window for treatment.
authors.affiliation: Department of Neurology, Yale University School of Medicine, Yale-New Haven Hospital, New Haven, Connecticut 06510, USA. richard.nowak@yale.edu
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Nowak
authors.forename: Hardik
authors.initials: H
authors.lastname: Amin
authors.forename: Kimberly
authors.initials: K
authors.lastname: Robeson
authors.forename: Joseph L
authors.initials: JL
authors.lastname: Schindler
mesh_terms: D000208:Acute Disease; D001766:Blindness / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology; D006801:Humans; D008269:Macular Edema / Q000209:etiology; D008297:Male; D008875:Middle Aged; D009460:Neurologic Examination; D011994:Recombinant Proteins / Q000008:administration & dosage; D020127:Recovery of Function; D015356:Retinal Artery Occlusion / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D015912:Thrombolytic Therapy; D013997:Time Factors; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage*; D016896:Treatment Outcome; D014792:Visual Acuity
chemical_list: D011994:Recombinant Proteins; D010959:Tissue Plasminogen Activator