Department of Neurology, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA.
Department of Neurology, Neurosurgery, and Translational Medicine, Barrow Neurological Institute, St. Joseph's Hospital, Phoenix, AZ, USA.
Int J Stroke. 2024 Jan;19(1):29-39. doi: 10.1177/17474930231189352. Epub 2023 Jul 27.
Whether thrombolysis improves outcomes in non-arteritic central retinal artery occlusion (naCRAO) is uncertain. We aimed to evaluate the rate of visual recovery after intra-venous thrombolysis (IVT) or intra-arterial thrombolysis (IAT) administration of tissue plasminogen activator (tPA) or urokinase among patients with naCRAO and explore the parameters affecting the final visual acuity (VA).
We systematically searched six databases. Logarithm of the minimum angle of resolution (logMAR) and VA of ⩾20/100 were used to quantify visual recovery. To explore the role of other factors on visual recovery, we defined two models for studies with aggregated data (designs 1 and 2) and 16 models for individual participant data (IPD, models 1-16).
We included data from 771 patients out of 72 publications in nine languages. Visual improvement for ⩾0.3 logMAR was reported in 74.3% of patients who received IVT-tPA within 4.5 h (CI: 60.9-86.0%; unadjusted rate: 73.2%) and 60.0% of those who received IAT-tPA within 24 h (CI: 49.1-70.5%; unadjusted rate: 59.6%). VA of ⩾20/100 was observed among 39.0% of patients after IVT-tPA within 4.5 h and 21.9% of those with IAT-tPA within 24 h. IPD models highlighted the association between improved visual outcomes and VA at presentation, at least 2 weeks follow-up before reporting the final VA, antiplatelet therapy, and shorter symptom onset to thrombolysis window.
Early thrombolytic therapy with tPA is associated with enhanced visual recovery in naCRAO. Future studies should refine the optimum time window for thrombolysis in naCRAO.
静脉内溶栓（IVT）或动脉内溶栓（IAT）给予组织型纤溶酶原激活剂（tPA）或尿激酶治疗非动脉炎性视网膜中央动脉阻塞（naCRAO）是否能改善结局尚不确定。我们旨在评估 naCRAO 患者接受 IVT-tPA 或 IAT-tPA 治疗后视力恢复的比例，并探讨影响最终视力（VA）的参数。
我们系统地检索了六个数据库。使用最小分辨角对数（logMAR）和 VA ⩾20/100 来量化视力恢复。为了探索其他因素对视力恢复的作用，我们为汇总数据研究定义了两个模型（设计 1 和 2）和 16 个个体参与者数据模型（IPD，模型 1-16）。
我们纳入了来自 9 种语言的 72 篇文献中的 771 例患者的数据。4.5 小时内接受 IVT-tPA 治疗的患者中，有 74.3%（95%CI：60.9-86.0%；未调整的比例：73.2%）和 24 小时内接受 IAT-tPA 治疗的患者中 60.0%（95%CI：49.1-70.5%；未调整的比例：59.6%）视力提高 ⩾0.3 logMAR。4.5 小时内接受 IVT-tPA 治疗的患者中，VA ⩾20/100 的比例为 39.0%，24 小时内接受 IAT-tPA 治疗的患者中，VA ⩾20/100 的比例为 21.9%。IPD 模型突出了视力改善结果与 VA 之间的相关性，即在报告最终 VA 之前至少 2 周的随访时 VA、抗血小板治疗和症状发作至溶栓时间窗更短。
naCRAO 患者早期溶栓治疗与视力恢复增强相关。未来的研究应该细化 naCRAO 中溶栓的最佳时间窗。
