Super-selective ophthalmic artery or selective carotid artery thrombolytic therapy for central retinal artery occlusion

Abstract

Objective To observe the clinical effect of super-selective ophthalmic artery or selective carotid artery thrombolytic therapy for central retinal artery occlusion (CRAO).Methods Twelve CRAO patients (12 eyes) were enrolled in this study.The patients included 7 males and 5 females.The age was ranged from 19 to 68 years old,with an average of (50.0t3.5) years.The disease duration was from 8 to 72 hours,with a mean of 18 hours.All the patients were received the treatment of super-selective ophthalmic artery or selective carotid artery thrombolysis with urokinase (total 0.20-0.4 million U) and injection of papaverine 30 mg.Five patients received the treatment of super-selective ophthalmic artery thrombolytic therapy,7 patients received the treatment of selective carotid artery thrombolytic therapy (4patients because of the financial issues,3 patients because of thin ophthalmic artery).According to the visual acuity of post-treatment and pre-treatment,the therapeutic effects on vision were defined as effective markedly (improving three lines or more),effective (improving two lines) and no effect (no change or a decline).According to the arm-retinal circulation time (A-Rct) and filling time of retinal artery and its branches (FT) on fluorescence fundus angiography (FFA),the therapeutic effects on retinal circulation were defined as effective markedly (A-Rct 15 s,FT 2 s),effective (A-Rct was improved but in the range of 16-20 s,FT was in 3-8 s) and no effect (A-Rct was improved but 21 s,FT 9 s).Results The vision changes showed effective markedly in 5 eyes (41.7％),effective in 5 eyes (41.7％),no effect in 2 eyes (16.6 ％).The total therapeutic efficiency on vision was 83.4％.The retinal circulation was improved in all eyes after treatment,including effective markedly in 8 eyes (67.0％),effective in 4 eyes (33.0％).The total therapeutic efficiency on retinal circulation was 100.0％.No complications occurred in these 12 patients during the treatment or follow up,such as puncture site hematoma,intracranial hemorrhage,cerebral embolism,eye movement abnormalities,retinal and vitreous hemorrhage.Conclusion Super-selective ophthalmic artery and selective carotid artery thrombolytic therapy were effective in the treatment of CRAO. Key words: Retinal artery occlusion/drug therapy; Thrombolytic therapy; Urinary plasminogen activator/therapeutic use