Richard G, Lerche R C, Knospe V, Zeumer H
Department of Ophthalmology, University Hospital Hamburg, Germany.
Ophthalmology. 1999 Apr;106(4):768-73. doi: 10.1016/S0161-6420(99)90165-3.
Retinal arterial occlusion is one of the most dramatic problems faced by ophthalmologists because of its sudden onset and the severe consequences it may have on the visual system. In this study, local intra-arterial fibrinolysis (LIF) using recombinant tissue plasminogen activator (rTPA) as a new technique for the treatment of retinal arterial occlusion was investigated.
Retrospective, noncomparative case series.
Strict inclusion and exclusion criteria were used to select patients for treatment. Fifty-three patients with central retinal artery occlusion (n = 46) or branch retinal arterial occlusion (n = 7) were enrolled.
For a maximum of 3 hours, 10- to 20-mg rTPA per hour in 50-ml sodium chloride was infused transfemorally by catheterization of the ophthalmic artery with a variable stiffness microcatheter.
The best-corrected visual acuity for distance by an 18-line logarithmic table was measured on admission, at 24 hours, and at 3 months after intervention.
At 3 months, visual acuity had improved in 35 (66%) of 53 patients. Twenty-five (47.2%) patients showed an improvement of more than 2 lines, and in 10 (18.8%) patients, improvements of 1 to 2 lines were observed. No change in visual acuity occurred in 12 (22.6%) patients, and in 6 (11.3%) patients, the visual acuity deteriorated. The mean occlusion time was 14 hours (range, 3-50 hours). No statistically significant correlation was found between occlusion time and visual outcome (P > 0.22). In two patients, a temporary slight hemiplegia was observed during catheterization, and in one patient, a hypertensive crisis after LIF treatment was observed.
The high success rate of LIF using rTPA in patients suffering from retinal arterial occlusion is supposedly due to a causal effect of rTPA on primary platelet-fibrin emboli and secondary thrombi. The local fibrinolytic therapy with rTPA involves little risk for patients selected by strict inclusion and exclusion criteria. It may be used for the treatment of retinal arterial occlusion even later than 8 hours after the acute visual loss. However, a successful outcome of the therapy depends on the prompt referral by well-informed ophthalmologists; a speedy execution of all internal, neurologic, and ophthalmologic diagnostic measures; and a prompt therapy.
视网膜动脉阻塞是眼科医生面临的最棘手问题之一，因其发病突然且可能对视系统造成严重后果。本研究探讨了使用重组组织型纤溶酶原激活剂（rTPA）进行局部动脉内纤溶治疗（LIF）作为治疗视网膜动脉阻塞的新技术。
回顾性、非对照病例系列研究。
采用严格的纳入和排除标准选择治疗患者。纳入53例视网膜中央动脉阻塞患者（n = 46）和视网膜分支动脉阻塞患者（n = 7）。
通过使用可变硬度微导管经股动脉插管至眼动脉，以每小时10 - 20 mg的rTPA溶于50 ml氯化钠溶液中，经动脉输注最长3小时。
在入院时、干预后24小时和3个月时，使用18行对数视力表测量最佳矫正远视力。
3个月时，53例患者中有35例（66%）视力有所改善。25例（47.2%）患者视力提高超过2行，10例（18.8%）患者视力提高1 - 2行。12例（22.6%）患者视力无变化，6例（11.3%）患者视力恶化。平均阻塞时间为14小时（范围3 - 50小时）。阻塞时间与视力结果之间未发现统计学显著相关性（P > 0.22）。2例患者在插管过程中出现暂时性轻度偏瘫，1例患者在LIF治疗后出现高血压危象。
在视网膜动脉阻塞患者中使用rTPA进行LIF治疗成功率高，推测是由于rTPA对原发性血小板 - 纤维蛋白栓子和继发性血栓具有因果作用。对于经严格纳入和排除标准选择的患者，rTPA局部纤溶治疗风险较小。即使在急性视力丧失8小时后，也可用于治疗视网膜动脉阻塞。然而，治疗成功取决于知识渊博的眼科医生及时转诊；迅速执行所有内科、神经科和眼科诊断措施；以及及时治疗。
