Stage-dependent efficacy of intra-arterial fibrinolysis in central retinal artery occlusion (CRAO)

Background: To find indications for intra-arterial fibrinolysis of CRAO. Method: A total of 46 patients with CRAO were treated with intra-arterial fibrinolysis (IF) using a microcatheter. The signs of CRAO were allotted to three different stages: I. incomplete CRAO; II. subtotal CRAO; III: CRAO with choroidal hypoperfusion (or with choroidal infarction). Results: Of the 46 patients treated with IF, 11 (24%) recovered their vision completely or showed a marked improvement after IF, and 17 (37%) showed a partial improvement. No remarkable changes were observed in 14 patients (30.4%), while visual acuity deteriorated in four patients (8.7%). In 30 of 46 patients (65.2%), urokinase was administered into the ophthalmic artery; in nine patients (19.6%), urokinase was injected into the internal maxillary artery (I Max); and in seven patients (15.2%), recombinant tissue plasminogen activator (r-TPA) was administered into the I Max. Almost all patients who showed a distinct or partial visual improvement were treated within the first 14 hours. Taking into account the different stages of CRAO, it is obvious that patients with fewer retinal signs have a better visual prognosis than patients with marked initial changes. Many patients who showed marked improvement after IF had incomplete CRAO. Conclusions: Therapy with IF has a beneficial effect in patients with CRAO who have slight edema of the central retina with no distinct signs of progression, who show well-perfused perimacular arterioles, and who are treated within 14 hours of the onset of blindness.