SELECTIVE THROMBOLYSIS OF CENTRAL RETINAL ARTERY-OCCLUSION WITHOUT LONG-TERM SYSTEMIC HEPARINIZATION

BACKGROUND A central retinal artery occlusion is a potentially blindin g retinal vascular event with no effective treatment regimen available . Recently, a few reports have described improved vision in eyes with central retinal artery occlusions after selective fibrinolytic therapy followed by longterm systemic anticoagulation. Acceptance of this tre atment, however, has been hampered by a paucity of confirmatory report s and its potential for producing serious hemorrhagic complications. O ur report independently confirms the beneficial effects of selective t hrombolysis, even with the use of only short-term, postprocedure syste mic heparinization. METHODS A case report of selective fibrinolysis of an occluded central retinal artery using urokinase infusion into the ophthalmic artery followed with only 12 h of systemic heparinization i s described. RESULTS A 65-year-old man presenting with a central retin al artery occlusion of less than Ph duration enjoyed an improvement of vision from counting-fingers acuity to 20/20 after selective fibrinol ysis with urokinase and only 12 h of systemic heparinization. No hemor rhagic or thrombotic complications occurred. CONCLUSIONS Selective thr ombolysis with urokinase followed by shortterm systemic heparinization can effectively treat a central retinal artery occlusion. Whereas the authors acknowledge that a single case does not prove that shortterm heparinization is better than long-term heparinization, it does show t hat the latter is not always required. (C) 1998 by Elsevier Science In c.