Abstract
Introduction: Branch retinal artery occlusion (BRAO) results from the blood flow compromise in of the branches of the central retinal artery. Data is limited on the outcome of patients with BRAO who received thrombolytic therapy as acute phase management protocol. Method: This study is a sub-analysis of our prior systematic review and meta-analysis on the visual outcome of patients with retinal artery occlusion who received intra-arterial (IA) or intra-venous (IV) thrombolytics within the first 24 hours. PubMed, Cochrane Library, ScienceDirect via Elsevier, International Clinical Trials Registry Platform (ICTRP), ClinicalTrials.gov, and Trip Medical Database were systematically searched with a predefined protocol to record the change in the visual acuity (VA) after thrombolytic therapy. We limited this study to the patients with BRAO who received urokinase (UK) or tissue plasminogen activator (tPA). Results: Among 1153 identified studies, 771 patients with retinal artery occlusion received thrombolytic therapy. BRAO was observed in 19 patients (2.5%, mean age: 65 years). IAT-tPA was administered in 8 (42.1%), IVT-tPA in 7 (36.8%), and IVT-UK in 4 (21.1%). Median time from the onset of visual change to thrombolysis was 6.0 [4.5-10.5] hours. Patients had mean baseline logarithm of the Minimum Angle of Resolution (logMAR) of 0.9±0.8. VA improvement of ≥0.1 logMAR (one Snellen line) was seen among 17 (89.5%), VA improvement of ≥0.3 logMAR (three Snellen lines) among 13 (68.4%), and a final VA of 20/100 or better among 16 (84.2%). One (5.3%) patient had intra-ocular hemorrhage post thrombolysis. Conclusion: Compared to central retinal artery occlusion, patient with branched retinal occlusion have better visual recovery following IA or IV thrombolysis. These results can be affected by the small number of the patients in this study.
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