Abstract
Purpose: To report successful treatment with transluminal Nd:YAG laser embolysis (TYE) combined with urokinase thrombolysis for reperfusion of occluded branch retinal arteries with visible emboli.Methods: A total of 34 eyes from 34 patients with acute, severe vision loss secondary to a branch retinal artery occlusion with visible emboli and retinal whitening were examined. Each patient was administered TYE therapy, which focused on the embolus, using an ocular contact lens; a 0.3–0.9 mJ laser pulse was delivered directly and gradually according to the reaction. Fundus photographs and fundus fluorescein angiography (FFA) were obtained before and immediately after the laser treatment. All patients received urokinase thrombolysis therapy drops intravenously for 5 days at 10–20 u/d. The follow-up period ranged from 6 to 14 months after therapy. The morphological characteristics of FFA associated with obstruction recovery of arterial fluorescence filling and visual function were analyzed.Results: After TYE therapy, FFA examinations showed that the retinal artery and its branches exhibited completely restored blood flow without obstruction in 13 eyes, accounting for 38.2% of the cases. The blood flow was mostly recovered in 11 eyes (32.4% of patients). FFA examinations following the combined intravenous urokinase thrombolysis therapy showed that the retinal artery and its branches exhibited completely restored blood flow after obstruction in 16 eyes (47.1% of patients). The blood flow was mostly recovered in 15 eyes (44.1% of patients).Conclusion: TYE combined with urokinase thrombolysis is effective for reperfusion of occluded branch retinal arteries and improving visual recovery in patients with visible emboli.
Highlights
Central retinal artery occlusion (CRAO) and branch retinal artery occlusion (BRAO) result in partial or complete retinal ischemia and sudden loss of vision
Retinal hemorrhage occurred in two eyes, and vitreous hemorrhage was found in one eye
Based on the dynamic contrast cycle of fluorescence filling during early recovery, the results were divided into the following groups: complete fluorescein filling of the artery and its branch vessels was defined as complete recovery of the obstruction; 2/3 fluorescein filling of the branch vessels was defined as mostly restored; 1/3 fluorescein filling of the branch vessels was defined as partially restored; and the absence of dye filling in any of branch vessels was defined as ineffective
Summary
Central retinal artery occlusion (CRAO) and branch retinal artery occlusion (BRAO) result in partial or complete retinal ischemia and sudden loss of vision. In most instances, these conditions are thought to be caused by an embolus, intraluminal thrombus, or atherosclerotic plaque. The main indication is BRAO with a visible embolus; this technique is not applicable for CRAO. This method consists of disrupting the intravascular embolus using a 1064 nm Nd:YAG laser focused on the embolus surface. Recent studies have indicated that Nd:YAG laser c 2018 The Author(s).
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