SELECTIVE INTRAARTERIAL FIBRINOLYSIS OF ACUTE CENTRAL RETINAL ARTERY-OCCLUSION

Background and Purpose-Occlusion of the central retinal artery (CRAO) causes a sudden decrease of monocular vision. Because early restoratio n of blood flow may improve outcome, we attempted to treat CRAO with s elective intra-arterial fibrinolysis. Methods-Intra-arterial fibrinoly sis was performed within 6 hours after symptom onset in 17 patients wi th thromboembolic CRAO. Symptoms were painless, acute and severe decre ase of vision, Urokinase (100 000 to 900 000 IU) was given through a m icrocatheter into the ophthalmic artery over 10 to 90 minutes. For com parison, the history and visual outcome of 15 control patients who did not receive fibrinolytics were evaluated. In both groups some of the patients underwent paracentesis and/or received carboanhydrase inhibit ors. Results-Patients who underwent fibrinolysis fared better than con trol patients (P=0.01). Three patients (17.6%) recovered completely af ter fibrinolysis and regained visual acuity of 20/20 (n=2) to 25/20 (n =1). Two additional patients (11.8%) showed a marked improvement to a visual acuity of 20/30. In 6 patients (35.3%) vision improved slightly . They were able to count fingers, detect hand movements, or perceive light. In 6 patients (35.3%), fibrinolytic treatment was without effec t. Among control patients, I patient (6.7%) showed partial, 4 patients (26.7%) minimal, and 10 (66.7%) no improvement of vision. Conclusions -A complete or marked improvement of visual acuity was achieved in one third of intra-arterial fibrinolysis patients but in none of the cont rol patients. Intra-arterial fibrinolysis seems to have the potential to ''lighten'' the spontaneously poor outcome of CRAO.