INTRAARTERIAL FIBRINOLYTIC THERAPY IN CENTRAL RETINAL ARTERY-OCCLUSION

We have treated 23 patients with central retinal artery occlusion by i ntra-arterial fibrinolysis. a method already in use for treatment of t hromboembolic occlusion of the cerebral arteries. Fibrinolysis was car ried out through a microcatheter placed in the origin of the ophthalmi c artery. When ophthalmic artery cannot be catheterised, treatment can be carried out indirectly via the maxillary-ophthalmic anastomoses. I n 18 cases urokinase was used in doses of 200000-1 200000 units, in 5 patients recombinant tissue plasminogen activator was used. Six patien ts showed marked improvement or total recovery, and six partial recove ry, with improvement of visual acuity or a field defect. The worst res ults were obtained in six patients where the mean delay between the ap pearance of symptoms and initiation of treatment was more than 20 h. I ntra-arterial thrombolysis led to a better outcome in acute occlusion of the central retinal artery than might have been expected with conse rvative treatment. A good prognosis is to be expected when treatment s tarts within the first 6-8 h, when some vision remains and when there is less retinal oedema.