Intravenous thrombolysis in central retinal artery occlusion as an effective and safe treatment

Q: What is the clinical evidence from this study?

Study design: Observational. Population: Central retinal artery occlusion (CRAO) (n=64). Intervention: Intravenous thrombolysis (IVT). Primary outcome: Improvement of vision in the affected eye (at least recognition of contours).

David Černík; Zuzana Eichlová; sona bikova; Petr Janský; Simona Vondrackova; Marta Vachova; Jan Macko; Roman Havlíček; Martina Odvárková; Jan Bilík; David Cihlář; Jiri Neumann

doi:10.5603/pjnns.108173

January 29, 2026Neurologia i Neurochirurgia PolskaOpen Access

Intravenous thrombolysis in central retinal artery occlusion as an effective and safe treatment

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Key result

IV thrombolysis linked to visual improvement in ~61% of central retinal artery occlusion patients.

n=64

Key Points

To evaluate the clinical efficacy and safety profile of intravenous thrombolysis in patients presenting with central retinal artery occlusion.
Evaluated visual outcomes, onset-to-treatment time (median 4.5 hours), hemorrhagic events on follow-up imaging, and rates of concurrent or subsequent acute ischemic stroke.
Visual improvement occurred in 60.9% of patients, with significant improvement (ability to read or recognize faces) in 39.1%, observed at an onset-to-treatment time of up to 17 hours.
Intracerebral hemorrhage appeared on 24-hour follow-up CT in 6.3% of patients, with one fatal symptomatic intracerebral hemorrhage (1.6%) in a patient with concurrent acute ischemic stroke, while 3-month mortality was 3.1% and 87.5% achieved functional independence (mRS ≤ 2).
Concurrent acute ischemic stroke was present at baseline in 9.4% of patients, and 17.2% developed acute ischemic stroke within one year of central retinal artery occlusion.

Study Design

Type

Observational (n=64)

Multicenter

Yes

PICO

P

Population

64 adults (mean age 67.9 years, 48.4% female) with acute central retinal artery occlusion and severe visual impairment treated with intravenous thrombolysis across 8 centers in the Czech Republic and followed for up to 1 year.

E

Exposure / Comparator

Intravenous thrombolysis (IVT)

O

Primary Outcome

Improvement of vision in the affected eye (at least recognition of contours)

Limitations

Retrospective study design
Lack of a more specific quantitative description of the resulting visual acuity
Probable underdiagnosis of atrial fibrillation among comorbidities due to inconsistent use of long-term Holter monitoring across the study duration
Single-arm design without a control group
Small sample size (N=64)

Implication

Observational study shows effective outcomes for intravenous thrombolysis in central retinal artery occlusion, suggesting safety and efficacy for treatment.

Abstract

Treatment of CRAO with IVT can be considered effective and safe. Secondary prevention should be in line with acute ischemic stroke (AIS) standards.

Discussion

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Cite This Study

Černík et al. (2026) conducted an observational in Central retinal artery occlusion (CRAO) (n=64). Intravenous thrombolysis (IVT) was evaluated on Improvement of vision in the affected eye (at least recognition of contours). Intravenous thrombolysis in central retinal artery occlusion resulted in visual improvement in 60.9% of patients (significant in 39.1%), with a 1.6% rate of symptomatic intracerebral hemorrhage.

synapsesocial.com/papers/6980fd18c1c9540dea80ee9d https://doi.org/10.5603/pjnns.108173

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Intravenous thrombolysis in central retinal artery occlusion as an effective and safe treatment

Key Points

Study Design

PICO

Limitations

Implication

Abstract

Discussion

Cite This Study

Intravenous thrombolysis in central retinal artery occlusion as an effective and safe treatment

Key Points

Study Design

PICO

Limitations

Implication

Abstract

Discussion

Cite This Study

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