title: Efficacy and safety of intra-arterial thrombolysis in central retinal artery occlusion.
abstract: OBJECTIVE
  To investigate the efficacy and safety of intra-arterial thrombolysis (IAT) for acute central retinal artery occlusion (CRAO).
  
  
  METHODS
  Records from 101 CRAO patients treated with either IAT (n = 57) or standard treatment (ST; n = 44) were retrospectively reviewed. ST consisted of ocular massage and intraocular pressure-lowering agents. We used fundoscopic and angiographic findings to categorize CRAO as incomplete (diminished visual acuity [VA] with slight retinal edema, slight cherry-red spot), subtotal (severe VA reduction, cherry-red spot, distinct retinal edema), or total (massive edema, occluded perimacular arterioles, additional choroidal blood flow interruption). One-month and final best-corrected VA (BCVA) of the IAT group were compared with those of the ST group. Early (≤3-day) and final (1-month) reperfusion (improvement of retinal perfusion) rates were compared between groups. Subgroup analyses were performed according to CRAO stage.
  
  
  RESULTS
  Overall, VA did not significantly differ between groups, but early reperfusion was greater in the IAT group (74.1% vs. 42.9%, P = 0.005). In incomplete CRAO, the IAT group exhibited greater visual improvement after 1 month (1.08 ± 0.21 vs. 0.23 ± 0.26 logarithmic values of the minimum angle of resolution [logMAR], P < 0.001) and at the final visit (1.08 ± 0.53 vs. 0.08 ± 0.57 logMAR, P < 0.001). However, in subtotal and total CRAO, no significant differences in visual outcomes were observed between groups. IAT resulted in clinically insignificant cerebral infarcts, detectable on brain imaging, in 8% of patients. Hemorrhagic transformation was not noted.
  
  
  CONCLUSIONS
  The IAT treatment may provide early restoration of retinal perfusion and offer functional benefits in the management of incomplete CRAO.
authors.affiliation: Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.
authors.forename: Seong Joon
authors.initials: SJ
authors.lastname: Ahn
authors.forename: Jae Min
authors.initials: JM
authors.lastname: Kim
authors.forename: Jeong-Ho
authors.initials: JH
authors.lastname: Hong
authors.forename: Se Joon
authors.initials: SJ
authors.lastname: Woo
authors.forename: Jeeyun
authors.initials: J
authors.lastname: Ahn
authors.forename: Kyu Hyung
authors.initials: KH
authors.lastname: Park
authors.forename: Moon-Ku
authors.initials: MK
authors.lastname: Han
authors.forename: Cheolkyu
authors.initials: C
authors.lastname: Jung
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005451:Fluorescein Angiography; D005500:Follow-Up Studies; D005654:Fundus Oculi; D006801:Humans; D007269:Injections, Intra-Arterial; D008297:Male; D008875:Middle Aged; D009880:Ophthalmic Artery; D012160:Retina / Q000503:physiopathology; D015356:Retinal Artery Occlusion / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology; D012189:Retrospective Studies; D015912:Thrombolytic Therapy / Q000379:methods*; D016896:Treatment Outcome; D014568:Urokinase-Type Plasminogen Activator / Q000008:administration & dosage*; D014792:Visual Acuity; D055815:Young Adult
chemical_list: D014568:Urokinase-Type Plasminogen Activator
keywords: central retinal artery occlusion; intra-arterial thrombolysis; outcome; reperfusion