Adamkiewicz Daniel V, Leal Christian, Yan Kevin Y, Arepalli Sruthi, Ferenchak Kevin, Cribbs Blaine, Lyons Riley J, Bénard-Séguin Étienne, Newman Nancy J, Biousse Valérie
Department of Ophthalmology, Emory University School of Medicine, Atlanta, GA, United States.
Department of Surgery, Section of Ophthalmology, University of Calgary, Calgary, AB, Canada.
Front Neurol. 2025 Aug 20;16:1631546. doi: 10.3389/fneur.2025.1631546. eCollection 2025.
The diagnosis of acute central retinal artery occlusion (CRAO) is commonly delayed in emergency departments (ED) where ophthalmologists are rarely available for immediate consultation. Thrombolysis is sometimes given empirically for presumed CRAO without confirmation of the diagnosis with ocular funduscopic examination.
We describe one case of severe intraocular hemorrhage following intravenous thrombolysis for a retinal detachment misdiagnosed as a CRAO, and two cases of worsening intraocular hemorrhage following intravenous thrombolysis for misdiagnosed CRAO, and review the literature.
We identified 4 cases in the literature were thrombolysis given for RAO resulted in ocular hemorrhage. We identified 12 additional cases where thrombolysis given for any indication resulted in intraocular hemorrhage.
Ocular hemorrhage is a rare but potentially devastating complication of thrombolysis in patients with underlying retinal disorders other than CRAO. Thrombolysis should never be given for acute vision loss without a funduscopic examination or ocular imaging confirming the diagnosis of CRAO.
急性视网膜中央动脉阻塞（CRAO）的诊断在急诊科通常会延迟，因为那里很少有眼科医生可供即时会诊。对于疑似CRAO的患者，有时在未通过眼底检查确诊的情况下就凭经验进行溶栓治疗。
我们描述了1例因视网膜脱离被误诊为CRAO而进行静脉溶栓后发生严重眼内出血的病例，以及2例因CRAO误诊而进行静脉溶栓后眼内出血加重的病例，并对相关文献进行了回顾。
我们在文献中发现4例因视网膜动脉阻塞（RAO）进行溶栓治疗导致眼内出血的病例。我们还另外发现12例因任何适应症进行溶栓治疗导致眼内出血的病例。
眼内出血是除CRAO外患有潜在视网膜疾病患者溶栓治疗罕见但可能具有毁灭性的并发症。在没有眼底检查或眼部成像确认CRAO诊断的情况下，绝不应因急性视力丧失而进行溶栓治疗。
