Intravenous thrombolysis in patients with central retinal artery occlusion: a systematic review and meta-analysis

Background and purpose To investigate the efficacy and safety of intravenous thrombolysis (IVT) with alteplase in patients with central retinal artery occlusion (CRAO). Methods We searched the database of PubMed and EMBASE for potentially eligible studies that reported IVT in CRAO patients from their dates of inception to May 19, 2021. The rate and odds ratios (OR) of best-corrected visual acuity (BCVA) improvement, mean difference (MD) of BCVA with 95% confidence interval (CI) were pooled with random effects model. Results We included 8 studies enrolling 316 CRAO patients, among them, 157 patients received IVT with alteplase while 159 patients did not. The rate of best BCVA improvement was 47% (95% CI 33-62%) in the CRAO patients treated with IVT, which was higher than that of 12% (95% CI 1-23%) in those without IVT (OR 5.97, 95% CI [2.77-12.86]). In the setting of similar baseline BCVA (MD [logMAR] 0.16, 95% CI [- 0.15 to 0.46]), compared with those who did not receive IVT, the CRAO patients who received IVT had better best BCVA (MD [logMAR] - 0.23, 95% CI [- 0.44 to - 0.02]), but had no significant better final BCVA (MD [logMAR] - 0.10, 95% CI [- 0.32 to 0.12]). Two CRAO patients had complicated symptomatic intracranial hemorrhage after IVT. Conclusions IVT treatment might be effective and safe for CRAO patients, but ocular-specific complications which were not associated with thrombolysis could affect final visual acuity.