Agarwal Nitin, Gala Nihar B, Baumrind Benjamin, Hansberry David R, Thabet Ahmad M, Gandhi Chirag D, Prestigiacomo Charles J
1 Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA.
2 Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
Vasc Endovascular Surg. 2016 Nov;50(8):579-581. doi: 10.1177/1538574416682158.
Central retinal artery occlusion (CRAO) is an ophthalmologic emergency due to the sudden cessation of circulation to the inner retinal layer. Without immediate treatment, permanent blindness may ensue. Several treatment options exist, ranging from noninvasive medical management to thrombolysis. Nonetheless, ongoing debate exists regarding the best therapeutic strategy.
The authors present the case of a 78-year-old woman with a medical history of hypercholesterolemia and rheumatoid arthritis who experienced complete loss of vision in her left eye. Following ophthalmologic evaluation demonstrating left CRAO, anterior chamber paracentesis was performed. Endovascular intervention was performed via local intra-arterial fibrinolysis with alteplase. Her vision returned to 20/20 following the procedure. In general, conventional therapies have not significantly improved patient outcomes.
Several management options exist for CRAO. In general, conservative measures have not been reported to yield better patient outcomes as compared to the natural history of this medical emergency. Endovascular approaches are another option as observed with this case reported. In cases of CRAO, therapeutic strategies such as intra-arterial fibrinolysis utilize a local infusion of reactive tissue plasminogen activator directly at the site of occlusion via catheterization of the ophthalmic artery. Although several case series do show promising results after treating CRAO with intra-arterial fibrinolysis, further studies are required given the reports of complications.
视网膜中央动脉阻塞（CRAO）是一种眼科急症，由于视网膜内层循环突然停止所致。若不立即治疗，可能会导致永久性失明。存在多种治疗选择，从无创药物治疗到溶栓治疗。尽管如此，关于最佳治疗策略仍存在持续的争论。
作者报告了一名78岁女性的病例，该患者有高胆固醇血症和类风湿关节炎病史，左眼完全失明。眼科评估显示为左CRAO后，进行了前房穿刺。通过使用阿替普酶进行局部动脉内纤维蛋白溶解术进行血管内介入治疗。术后她的视力恢复到了20/20。一般来说，传统疗法并未显著改善患者的预后。
CRAO有多种治疗选择。一般而言，与这种医疗急症的自然病程相比，保守措施并未被报道能产生更好的患者预后。正如本病例报告中所观察到的，血管内治疗方法是另一种选择。在CRAO病例中，诸如动脉内纤维蛋白溶解术等治疗策略是通过经眼动脉插管将活性组织纤溶酶原激活剂直接局部注入阻塞部位。尽管有几个病例系列确实显示动脉内纤维蛋白溶解术治疗CRAO后有令人鼓舞的结果，但鉴于有并发症的报告，仍需要进一步研究。
