Introduction Central retinal artery occlusion (CRAO) is considered an ophthalmologic emergency. The effectiveness of intra-arterial thrombolysis (IAT) remains controversial. Non-invasive standard therapies are often employed but their efficacy compared to no treatment is also controversial. Similar to emergent large vessel occlusion stroke, time to revascularization may be critically important with lower times possibly favoring improved visual outcomes. We performed a systematic review of the literature to determine whether evidence exists for improvement in vision after IAT and whether that improvement varied with time.
Methods A comprehensive literature search was conducted in MEDLINE (1946–January 2015) for the following medical keywords: intra-arterial thrombolysis; retinal artery occlusion; intra-arterial fibrinolysis; and retinal artery. Additional articles were identified by review of the reference sections of each article. Inclusion criteria consisted of articles written in English, micro catheter directed infusion of thrombolytic (tPA, urokinase, streptokinase), individual patient data for visual outcomes and time from onset to IAT therapy. LogMAR scores were either abstracted directly from the data or converted from Snellen chart scores. The numerical scores for profound vision loss (counting fingers or worse) were substituted for logMAR scores as suggested by Lange et al.1
Results Five studies met the inclusion criteria supplying individual data on 115 patients.2–6 The mean and median time to IAT were 12.2 (SD 10.4) and 9 (IQR 6.9,12) hours respectively. Mean logMAR improvement was 0.61 (SD 0.68). A Shapiro-Wilk test of normality demonstrated non-parametric data and a paired-samples Wilcoxan Signed Rank test was performed on pre- and post-IAT treatment logMAR scores. This demonstrated a significant median improvement of 0.4 [IQR: 0, 1.06] (P < 0.0001). Non-parametric ANOVA demonstrated no relationship between change in logMAR and time to treatment. Patients treated in 4 h or less demonstrated a trend towards superior mean logMAR improvement compared to other time cut-offs but this is not significant (Figure 1).
Conclusions IAT therapy demonstrates a significant improvement in logMAR scores when comparing pre- and post-IAT therapy visual assessments. Time to treatment showed a trend towards superior improvement in patients treated in less than 4 h but this was not significant.
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Disclosures P. Page: None. A. Cambon: None. R. James: 1; C; Microvention, Inc. Industry sponsored and Investigator-Initiated Research Support, Penumbra, Inc.; Investigator-Initiated Research Support. 2; C; Pulsar Vascular, Inc.; Clinical Events Committee Member, Covidien, Inc.; Clinical Events Committee Member. 4; C; Remedy Pharmaceuticals, Inc.
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