USEFULNESS OF INTRAARTERIAL FIBRINOLYSIS OF THE OPHTHALMIC ARTERY 8 HOURS OR MORE AFTER CENTRAL RETINAL ARTERY-OCCLUSION

Purpose To establish that intra-arterial fibrinolysis of the ophthalmi c artery can still be efficient 8 hours or more after a central retina l artery occlusion. Materials and methods Nine to twenty hours (averag e 12.5 H) after a loss of vision due to a central retinal artery occlu sion or the occlusion of its branches, 7 patients were treated by intr a-arterial fibrinolysis. The vision of the affected eye was limited to light perception for four patients, to hand movement at 1 meter for t wo patients, and to 4/10 P2 for one patient. Under radiological guidan ce, 300.000 IU of urokinase was injected through a microcatheter place d in the ophthalmic artery (6 patients) or in the facial artery (1 pat ient); in this case the angiogram showed an occlusion of the internal carotid artery and a retrograde filling of the ophthalmic artery throu gh the facial artery. Results We did not observed any complication. Th e 3 patients who had a vision better than light perception recovered a vision of 10/10 P2. For the others: two patients recovered a vision o f 9/10 P2 and 5/10 P2, two did not recover. Conclusion Fibrinolysis of the ophthalmic artery must ideally be performed as soon as possible, but a recovery is still possible more than 8 hours after the onset of the loss of vision. The time limit is not yet defined but after 24 hou rs, the chance of improvement seems to be very low.