Department of Ophthalmology, Wonkwang University College of Medicine, Iksan, Korea.
Department of Neurosurgery, Wonkwang University College of Medicine, Iksan, Korea.
Korean J Ophthalmol. 2021 Aug;35(4):261-271. doi: 10.3341/kjo.2020.0082. Epub 2021 Jun 21.
The purpose of this study was to determine the efficacy and safety of selective intra-arterial thrombolysis in patients with central retinal artery occlusion (CRAO).
Medical records for 44 eyes of 44 patients diagnosed with acute non-arteritic CRAO and thrombolysis between October 2010 and February 2019 were analyzed retrospectively. Based on visual acuity, fundoscopic findings, and fluorescein angiography, the patients were classified into three stages: incomplete, subtotal, and total. The perfusion state using the best-corrected visual acuity (BCVA), arm to retina time, and arteriovenous passage times, after 1 month, 6 months, and at the final visit after the procedure, were compared with baseline readings.
Improvement of visual acuity was confirmed in 31 out of 44 patients (70.45%). The mean BCVA of 44 patients changed from 1.65 ± 0.78 logarithmic minimum angle of resolution (logMAR) at the first visit to 1.18 ± 0.91 logMAR at the last visit (p = 0.114). The BCVA according to CRAO stage was 0.08 ± 0.11 logMAR for the incomplete stage at the first visit, 0.06 ± 0.05 logMAR (p = 0.933) 1 month after the procedure, and 0.05 ± 0.07 logMAR (p = 0.933) at the last visit. In the subtotal stage, the results were 1.81 ± 0.54 logMAR at the first visit, 1.63 ± 0.76 logMAR (p = 0.035) 1 month after the procedure, and 1.36 ± 0.85 logMAR (p = 0.014) at the last visit. For the total stage of BCVA, the result at the first visit was 2.36 ± 0.25 logMAR, and it was 2.30 ± 0.30 logMAR (p = 0.510) 1 month after the procedure, and 2.42 ± 0.30 logMAR (p = 0.642) at the last visit. Reperfusion was observed in 40 patients out of the 44 (90.91%).
Selective intra-arterial thrombolysis can be helpful in patients with subtotal CRAO in terms of visual improvement and retinal arterial reperfusion.
本研究旨在确定选择性动脉内溶栓治疗视网膜中央动脉阻塞（CRAO）的疗效和安全性。
回顾性分析 2010 年 10 月至 2019 年 2 月期间接受急性非动脉炎性 CRAO 溶栓治疗的 44 例 44 只眼的病历资料。根据视力、眼底表现和荧光素血管造影，患者分为不完全、次全和完全 3 期。将最佳矫正视力（BCVA）、手臂到视网膜时间和动静脉通过时间的灌注状态与基线读数进行比较，比较时间点为 1 个月、6 个月和治疗后末次随访。
44 例患者中有 31 例（70.45%）视力得到改善。44 例患者的平均 BCVA 从首次就诊时的 1.65±0.78 对数最小角分辨率（logMAR）变化至末次就诊时的 1.18±0.91 logMAR（p=0.114）。根据 CRAO 分期，不完全期首次就诊时为 0.08±0.11 logMAR，术后 1 个月时为 0.06±0.05 logMAR（p=0.933），末次就诊时为 0.05±0.07 logMAR（p=0.933）。次全期结果分别为首次就诊时 1.81±0.54 logMAR，术后 1 个月时 1.63±0.76 logMAR（p=0.035），末次就诊时 1.36±0.85 logMAR（p=0.014）。对于完全期的 BCVA，首次就诊时为 2.36±0.25 logMAR，术后 1 个月时为 2.30±0.30 logMAR（p=0.510），末次就诊时为 2.42±0.30 logMAR（p=0.642）。44 例患者中有 40 例（90.91%）出现再灌注。
选择性动脉内溶栓治疗对次全性 CRAO 患者的视力改善和视网膜动脉再灌注有帮助。
