Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.
Invest Ophthalmol Vis Sci. 2013 Nov 21;54(12):7746-55. doi: 10.1167/iovs.13-12952.
To investigate the efficacy and safety of intra-arterial thrombolysis (IAT) for acute central retinal artery occlusion (CRAO).
Records from 101 CRAO patients treated with either IAT (n = 57) or standard treatment (ST; n = 44) were retrospectively reviewed. ST consisted of ocular massage and intraocular pressure-lowering agents. We used fundoscopic and angiographic findings to categorize CRAO as incomplete (diminished visual acuity [VA] with slight retinal edema, slight cherry-red spot), subtotal (severe VA reduction, cherry-red spot, distinct retinal edema), or total (massive edema, occluded perimacular arterioles, additional choroidal blood flow interruption). One-month and final best-corrected VA (BCVA) of the IAT group were compared with those of the ST group. Early (≤3-day) and final (1-month) reperfusion (improvement of retinal perfusion) rates were compared between groups. Subgroup analyses were performed according to CRAO stage.
Overall, VA did not significantly differ between groups, but early reperfusion was greater in the IAT group (74.1% vs. 42.9%, P = 0.005). In incomplete CRAO, the IAT group exhibited greater visual improvement after 1 month (1.08 ± 0.21 vs. 0.23 ± 0.26 logarithmic values of the minimum angle of resolution [logMAR], P < 0.001) and at the final visit (1.08 ± 0.53 vs. 0.08 ± 0.57 logMAR, P < 0.001). However, in subtotal and total CRAO, no significant differences in visual outcomes were observed between groups. IAT resulted in clinically insignificant cerebral infarcts, detectable on brain imaging, in 8% of patients. Hemorrhagic transformation was not noted.
The IAT treatment may provide early restoration of retinal perfusion and offer functional benefits in the management of incomplete CRAO.
探讨动脉内溶栓（IAT）治疗急性中央视网膜动脉阻塞（CRAO）的疗效和安全性。
回顾性分析 101 例接受 IAT（n=57）或标准治疗（ST；n=44）的 CRAO 患者的病历资料。ST 包括眼球按摩和降眼压药物。我们根据眼底和血管造影结果将 CRAO 分为不完全型（视力轻度下降[VA]，轻度视网膜水肿，轻度樱桃红斑）、次全型（VA 严重下降，樱桃红斑，明显视网膜水肿）和完全型（大量水肿，黄斑区周边小动脉闭塞，脉络膜血流中断）。比较 IAT 组和 ST 组患者治疗后 1 个月和最终最佳矫正视力（BCVA）。比较两组患者的早期（≤3 天）和最终（1 个月）再通（视网膜灌注改善）率。根据 CRAO 分期进行亚组分析。
总体而言，两组患者的视力无显著差异，但 IAT 组的早期再通率更高（74.1% vs. 42.9%，P=0.005）。在不完全型 CRAO 中，IAT 组治疗后 1 个月的视力改善更明显（1.08±0.21 vs. 0.23±0.26 最小分辨角对数视力[logMAR]，P<0.001）和最终随访时（1.08±0.53 vs. 0.08±0.57 logMAR，P<0.001）。然而，在次全型和完全型 CRAO 中，两组患者的视力结果无显著差异。IAT 治疗后 8%的患者出现可在脑部影像学检查中检测到的临床意义不显著的脑梗死。未发生出血性转化。
IAT 治疗可能有助于早期恢复视网膜灌注，并为不完全型 CRAO 的治疗提供功能获益。
