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Lillian Yang; Retrospective review of interventional thrombolysis for central retinal artery occlusion at the University of Kansas Medical Center.. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):4869.
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Thrombolysis has been proposed as a treatment in patients with central retinal artery occlusion (CRAO). The aim of this study is to review the University of Kansas’ experience in treating CRAO using intra-arterial t-PA to assess the safety and effectiveness of the procedure by measuring outcomes and complications.
Records from seven patients diagnosed with central retinal artery occlusion and treated with intra-arterial tPA were retrospectively reviewed for ophthalmic findings before and after treatment as well as complications after treatment.
Two patients had stable visual acuity before and after treatment given 9 and 5 hours, respectively, after onset of symptoms. Three patients had improved vision from hand motion to 20/20, count fingers at 1 ft to count fingers at 4 ft, and light perception to hand motion, given 11 hours, 14 hours, and unknown duration respectively after onset of symptoms. The patient with hand motion improvement to 20/20 was noted to have a patent cilioretinal artery on fundoscopic exam. Two patients had a decrease in vision, both light perception to no light perception, treated 7.5 hours and 8 hours, respectively, after onset of symptoms. The range of time to tPA after onset of symptoms was 1.5 hours to 17 hours. All patients were worked up with ESR and CRP to rule out giant cell arteritis. One patient experienced oral cavity hemorrhage day one after intra-arterial tPA but did not have intracranial hemorrhage.
Overall, most patients that received treatment with intra-arterial tPA did not have significant improvement in visual acuity when checked 1-4 days post treatment. One patient did experience a significant improvement in visual acuity however, the patient had a patent cilioretinal artery on funduscopic exam which may have been responsible for the improvement. One patient suffered a minor complication of oral hemorrhage without intracranial hemorrhage.
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