Selective intraarterial fibrinolysis of acute central retinal artery occlusion

Purpose: To evaluate the outcome of our patients with central retinal artery occlusion after local fibrinolysis and to compare these data with results reported in the literature. Material and Methods: Over a period of 7 years, 22 patients (11 male, 11 female, mean age 64.6 +/- 12.1 years) were treated with super-selective local fibrinolysis. In 1 case, treatment was carried out via the maxillary-ophthalmic anastomoses due to preexisting occlusion of the ipsilateral internal carotid artery. The latency period from the onset of symptoms to the beginning of therapy was 7.6 +/- 1.8 h. Urokinase was used in 7 cases (300,000-1.1 million units) and recombinant tissue plasminogen activator (20-40 mg) was applied in 15 patients. Visual acuity and fundus were examined before and after treatment. Results: One patient (1/22 = 4.6%) recovered completely and regained a visual acuity of 20/20. Six patients (6/22 = 27.3%) showed a marked improvement with a range of visual outcome from 20/800 to 20/320. In 2 cases (2/22 = 9.1%) only a slight improvement was observed, with a visual outcome allowing detection of hand movements. In 13 cases (13/22 = 59.1%) no change in visual acuity as a result of treatment was observed. In 2/22 cases (9.2%) reversible neurological side-effects occurred, in 1 case suffered a stroke, and in another case intracerebral bleeding was observed. Conclusion: In our study, the recovery of visual acuity and the complication rate were not as positive as reported in the literature.