Huang Lele, Wang Yujie, Zhang Ruijun
Department of Ophthalmology, The First Affiliated Hospital of China Medical University, 155 Nanjingbei Street, Heping District, Shenyang, 110001, People's Republic of China.
Department of Neurology, People's Hospital of Liaoning Province, 33 Wenyi Road, Shenhe District, Shenyang, 110016, People's Republic of China.
Graefes Arch Clin Exp Ophthalmol. 2023 Jan;261(1):103-113. doi: 10.1007/s00417-022-05797-1. Epub 2022 Aug 10.
To investigate the efficacy and safety of intra-arterial thrombolysis (IAT) in patients with central retinal artery occlusion (CRAO).
PubMed and EMBASE were searched for potentially eligible studies that reported IAT in CRAO patients from inception to Nov 8, 2021. Standard mean difference (SMD) was pooled to compare visual acuity (VA) at baseline with final in IAT patients. The rates and odds ratios (OR) were meta-analyzed to compare VA improvement in IAT with non-IAT patients, stratified to different times from onset to procedure, different definitions of VA improvement, and three CRAO stages. Adverse effects were recorded.
Fifteen studies were included, enrolling 507 CRAO patients who received IAT and 296 CRAO patients who did not. VA was significantly improved from baseline to final VA in IAT patients (SMD [LogMAR] 0.70, 95% CI [0.51, 0.90]). VA improvement rate was higher in IAT patients than that in non-IAT (56% vs 32%, OR 3.55, 95%CI [1.74, 7.24]), with greater OR in IAT within 6 h from onset to procedure (OR 4.60, 95%CI [1.24, 16.99]) than that beyond 6 h (OR 3.36, 95%CI [1.43, 7.85]). The benefit remained consistent when VA improvement was defined as ≥ 3 lines on the Snellen chart (OR 4.68, 95%CI [2.10, 10.41]) and was even greater when CRAO was incomplete. Five patients had a symptomatic intracranial hemorrhage and 21 patients had ischemic stroke or transient ischemic attack after IAT.
IAT treatment has certain potential in ameliorating VA in CRAO patients, which should be balanced against cerebral complications.
探讨动脉内溶栓（IAT）治疗视网膜中央动脉阻塞（CRAO）患者的疗效和安全性。
检索PubMed和EMBASE数据库，查找自数据库建库至2021年11月8日期间报道IAT治疗CRAO患者的潜在合格研究。汇总标准均差（SMD）以比较IAT治疗患者基线视力与最终视力。对IAT治疗与非IAT治疗患者的视力改善率及比值比（OR）进行荟萃分析，按发病至治疗的不同时间、视力改善的不同定义以及CRAO的三个阶段进行分层。记录不良反应。
纳入15项研究，共纳入507例接受IAT治疗的CRAO患者和296例未接受IAT治疗的CRAO患者。IAT治疗患者的视力从基线至最终视力有显著改善（SMD[LogMAR]0.70，95%CI[0.51，0.90]）。IAT治疗患者的视力改善率高于非IAT治疗患者（56%对32%，OR 3.55，95%CI[1.74，7.24]），发病至治疗6小时内接受IAT治疗的患者OR值（OR 4.60，95%CI[1.24，16.99]）高于6小时后接受IAT治疗的患者（OR 3.36，95%CI[1.43，7.85]）。当将视力改善定义为在Snellen视力表上提高≥3行时，获益仍然一致（OR 4.68，95%CI[2.10，10.41]），且在不完全性CRAO患者中获益更大。5例患者在IAT治疗后出现症状性颅内出血，21例患者出现缺血性卒中或短暂性脑缺血发作。
IAT治疗在改善CRAO患者视力方面具有一定潜力，但应权衡其与脑部并发症的风险。
