Purpose Central retinal artery occlusion (CRAO) is an ophthalmic emergency that can result in profound monocular visual loss, but there is currently no treatment guideline. Two randomized controlled trials have looked at the use of tPA for treatment of CRAO (one intra-arterial, another intravenous approach), but their results were not promising, especially when the treatment was given after 12 hours from symptom onset. Anterior chamber (AC) paracentesis is a method to lower intraocular pressure to increase optic nerve head perfusion gradient, but its effectiveness in CRAO is also not proven in literature. The purpose of this study was to retrospectively investigate the efficacy of early (defined as treated within <12 hours from symptom onset) local intravascular fibrinolysis (tPA) with and without paracentesis for patients with central retinal artery occlusion.
Methods 72 consecutive patients who presented to the Mount Sinai Hospital and was diagnosed with central retinal artery occlusion between January 2015 – December 2017 were included in this retrospective review. For each patient, the treatment choice (intravascular fibrinolysis, intravascular fibrinolysis with anterior chamber paracentesis, or conservative non-thrombolytic treatment) and post-treatment visual acuity was recorded. Visual acuity 3 weeks and 6 weeks after treatment of CRAO were reviewed.
Results Out of 72 patients, only 6 received vascular intervention of interest. All 6 patients (5 female, 1 male, mean age 59, 3 OS, 3 OD) received intra-arterial (IA) tPA treatment. 3 patients underwent AC paracentesis prior to IA tPA treatment, and visual acuity improvement was observed in 2 out of these 3 cases. The other 3 patients had IA tPA treatment without AC paracentesis, and visual acuity improvement was observed in 2 out of these 3 cases. In total, visual acuity improved in 4 out of 6 patients who received IA tPA. In the 2 cases without visual acuity improvement, the visual acuity level remained same as pre-intervention. Notably, for one patient who presented with a right CRAO and a left CRAO 2 weeks later, treatment of left CRAO with AC paracentesis and IA tPA resulted in improved visual acuity in both eyes.
Conclusion Currently, only a small proportion of patients diagnosed with central retinal artery occlusion undergo vascular intervention, but IA tPA treatment may improve visual acuity. AC paracentesis prior to IA tPA did not appear to affect visual acuity outcome compared to treatment with only IA tPA.
Disclosures Y. Sakai: None. J. Chelnis: None. R. De Leacy: None.
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