Thrombolysis for Central Retinal Artery Occlusion

Highlights

This systematic review and meta-analysis investigated whether administration of thrombolytic agents intravenously (within the first 4.5 h) or intra-arterial (within the first 24 h) is beneficial for visual recovery in patients with central artery occlusion. the non-arteritic retina.
Overall, three-quarters of patients reported remarkable visual recovery after administration of intravenous or intra-arterial thrombolytic therapy. A shorter duration of thrombolytic agent administration was associated with better clinical outcomes.
Intraocular hemorrhage was observed in less than 1% of patients and was only observed in the intra-arterial group, and symptomatic intracerebral hemorrhage was observed in 1% of patients.
This study demonstrates that administration of thrombolytics intravenously (within the first 4.5 hours) or intra-arterial (within the first 24 hours) in patients with non-arteritic central retinal artery occlusion is safe and improves recovery. visual.

Background

It is not known whether thrombolysis improves outcomes in non-arteritic central retinal artery occlusion (NACRAO).

We aimed to evaluate the rate of visual recovery after intravenous thrombolysis (IVT) or intra-arterial thrombolysis (IAT) of tissue plasminogen activator (tPA) or urokinase among patients with naCRAO and explore the parameters affecting final visual acuity (VA). ).

Methods

Six databases were systematically searched. The logarithm of the minimum angle of resolution (logMAR) and VA of ⩽20/100 were used to quantify visual recovery. To explore the role of other factors in visual recovery, we defined two models for studies with aggregated data (designs 1 and 2) and 16 models for individual participant data (IPD, models 1-16).

Review Summary

Data from 771 patients from 72 publications in nine languages were included.

A visual improvement of ⩾0.3 logMAR was reported in 74.3% of patients who received IVT-tPA within 4.5 h (CI: 60.9-86.0%; unadjusted rate: 73. 2%) and in 60.0% of those who received IAT-tPA within 24 h (CI: 49.1-70.5%; unadjusted rate: 59.6%).

VA of 20/100 was observed in 39.0% of patients after IVT-tPA within 4.5 h and in 21.9% of those with IAT-tPA within 24 h.

IPD models highlighted the association between improved visual outcomes and VA at presentation, at least 2 weeks of follow-up before reporting final VA, antiplatelet therapy, and shorter symptom onset to thrombolysis window.

Conclusion

Early thrombolytic therapy with tPA is associated with greater visual recovery in naCRAO.
Future studies should refine the optimal time window for thrombolysis in naCRAO.

Thrombolysis for Central Retinal Artery Occlusion

Three-quarters of patients reported remarkable visual recovery following thrombolysis for central retinal artery occlusion, highlighting the potential benefits of timely intervention in preserving vision in affected individuals.