Intravenous Fibrinolytic Therapy in Central Retinal Artery Occlusion

Abstract

Most cases of untreated central retinal artery occlusion (CRAO) do have a very bad prognosis. Thrombolytic therapy of acute CRAO has shown promising results in the past few years. However, there is still a great deal of confusion about the initial therapeutic management. No therapy is available so far that has unequivocally proven effective. We report on systemic fibrinolytic therapy with tissue plasminogen activator (rt-PA) which was done in five cases with CRAO and four cases with retinal artery branch occlusion, with respect to the contraindications. A fluorescence angiography of the fundus preceded therapy in 4 cases. All patients were treated with 70-100 mg of rt-PA intravenously over 60 minutes. 8 patients received heparin and 3 were also treated by vasoactive infusions. Improvement in visual acuity could be seen in 6 patients, 2 had no change in vision and one had a small decline from 1.0 pp to 0.8. There was one serious complication with intracerebral hemorrhage followed by dysarthria and persisting hemiparesis. 29% of the patients investigated by duplex-ultrasound (n = 7) were having serious (i.e. over 70%) arterial stenoses of the carotid area with hemodynamic consequences. Neurosurgical desobliteration was indicated in one patient.