Abstract
Purpose :
Central retinal artery occlusion (CRAO) is an emergency that may cause severe and irreversible visual loss. Conventional treatment is mostly insufficient. Several studies reported beneficial effects of therapy with thrombolytic agents administered intravenously in the first few hours after the event. This study evaluates the efficacy of intravenous thrombolysis with low dose plasminogen in the first 4.5 hours after CRAO versus that of conservative treatment.
Methods :
We evaluated a consecutive case series of 13 patients presenting with CRAO over a time period of 18 months. All patients with the onset of symptoms within the first 4,5 hours received low dose plasminogen (0.6 mg/kG) intravenously. Before treatment, systemic contraindications such as: intracranial hemorrhage, previous trauma or surgery, internal bleeding, uncontrolled hypertension and arteriovenous malformation, were excluded. After infusion, patients were monitored in the stroke unit for 48 hours.
Patients whose symptoms began more than 4.5 hours before admission received oral anticoagulation and pentoxifylline-infusions. Cardiovascular risk factors of all patients were evaluated.
Results :
At admission all patients presented with visual acuity of hand motion or light perception. In the thrombolysis group mean visual acuity improved after the treatment to 0.6±0.42. Residual defects in the visual field remained in all patients. In the group treated with the conventional therapy, no gain of vision was observed. No systemic complications occurred after the thrombolytic treatment.
Conclusions :
Patients with CRAO with the onset of symptoms within the first 4.5 hours may benefit from thrombolysis with low dose plasminogen. The visual improvement may be superior compared to the effects of the conventional treatment. Therapy should be considered for selected patients after excluding the systemic contraindications.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.