[Thrombolysis in central retinal artery occlusion using alteplase].

AIM

The systemic acute thrombolysis (fibrinolysis) is one of methods how to treat occlusion of the central retinal artery. We present our first results of this rarely used treatment.

MATERIAL AND METHODS

The patients were treated by means of i.v. infusion of the fibrinolytic alteplasis (plasminogen tissue activator, Actilyse) with the dose 0.9 mg/kg of body weight, first as a bolus of 10% of the dose, the rest was slowly applied while monitoring vital functions and coagulations parameters. The contraindications of the thrombolysis are especially tumors, bleeding, any surgery in last three months, and the brain stroke in the medical history, and diseases of the liver and kidneys. From November 2006 to April 2007, we treated 5 patients by means of thrombolysis; two patients with the occlusion of the temporal branch retinal artery (BRAO) with characteristic quadrant scotoma of the visual field and decrease of the visual acuity, and three patients with central retinal artery occlusion or hemi-occlusion (CRAO).

RESULTS

The central visual acuity improved in all patients the next day after the thrombolysis. Both patients with the branch retinal artery occlusion had visual acuity 1.0, the delay between the thrombosis and the treatment was more than 12 hours. In two out of three patients with the central occlusion the visual acuity improved from practical blindness to 0.66. The third patient came with the latency of more than 30 hours; he registered partial improvement shortly after the thrombolysis, but later, the visual acuity decreased again.

CONCLUSION

The thrombolytic treatment is definitely an advantage comparing to the conservative treatment. According to many contraindications and possible complications, it is necessary to select the eligible patient carefully. The treatment can be done on specialized in-patient department with the possibility to monitor vital functions and coagulations factors during the treatment as well as after it. In four out of five of our patients, the treatment finished with fast recovery of visual acuity almost to the normal.The effect of the treatment was good up to 18 hours after the occlusion; after 30 hours it was bad.