Central retinal artery occlusion. Importance of selective intra-arterial fibrinolysis

Background. Conventional treatment of a central retinal artery occlusion us ually has a poor prognosis but intra-arterial fibrinolysis (IF) of the opht halmic artery is an invasive treatment option. The importance of IF was eva luated in 62 patients with central retinal artery occlusion and in addition the risk spectrum for this disease was considered. Material and methods. Data from charts of 62 patients were retrospectively analysed. Visual recovery after IF (n=17) was compared to conventional trea tment (e.g. decrease of IOP, improvement of rheological conditions, n=45). Patients were excluded from IF if the occlusion was present for more than 8 h, if there was a history of bleeding and previous operations, or if they were older than 85 years. IF was performed using either urokinase (n=7) or tPA (n=10). Results. Out of 62 patients, 22 (35%) with central retinal artery occlusion underwent catheterisation. Stenosis of the carotid artery excluded IF in 5 out of these 22 cases, therefore only 17 patients were treated by IF. Of t he patients, 40 (65%) were excluded from IF for various reasons: 47% (19/40 ) arrived later than 8 h after occlusion, 17% (7/40) did not consent to IF, 15% (6/40) had medical contraindications and 13% (5/40) were over 85 years of age. Two patients required no IF because of a cilioretinal anastomosis with moderate visual acuity and another patient showed spontaneous visual r ecovery during ophthalmic examination. Of the 17 patients treated with IF, 4 achieved an improvement of visual acuity by more than 2 lines, no change of visual acuity was observed in 12/17 patients and 1/17 lost more than 2 l ines after treatment. Of the 45 conservatively treated patients, 16 achieve d improvement by more than 2 lines and no change occurred in 29/45 patients . Three patients treated with IF suffered from a stroke during treatment. T he main risk factor for central retinal artery occlusion was high blood pre ssure in 32% of all cases and nicotine abuse in 16%. Conclusions. Many patients presented too late for IF. However, there was no statistical difference between patients with IF and conventional treatment with regards to the improvement of visual acuity. Additionally there is an increased risk of a stroke from IF, therefore a prospective study is neces sary to evaluate the importance of IF. Stabilisation of high blood pressure may be the best prophylaxis for preventing a central retinal artery occlus ion.