Effect of papaverine hydrochloride on functional visual acuity in non-arteritic central retinal artery occlusion: a retrospective cohort study

Background Non-arteritic central retinal artery occlusion (NA-CRAO) is an acute ocular emergency that frequently results in severe and irreversible vision loss with limited therapeutic options. Papaverine hydrochloride, a non-specific vasodilator commonly used to relieve vasospasm, has not been previously evaluated for its potential benefits for visual recovery in patients with NA-CRAO. Therefore, this study aims to investigate the association between papaverine hydrochloride treatment (PHt) and functional visual acuity improvement in patients with NA-CRAO. Methods Propensity-score matching was used to retrospectively collect clinical data of 104 NA-CRAO patients with similar baseline characteristics. The patients were categorized into a PHt group (n = 52) and a non-papaverine hydrochloride treatment (non-PHt) group (n = 52). The primary outcome was functional visual acuity (best-corrected visual acuity ≥20/100) assessed at discharge and at a 1-month follow-up. Logistic regression and subgroup analyses were performed to evaluate the associations between papaverine hydrochloride use and improvements in functional visual acuity. Results The PHt group showed significantly higher functional visual acuity than the non-PHt group at discharge (32.7% vs. 15.4%, p = 0.039) and at the 1-month follow-up (53.8% vs. 34.6%, p = 0.048). In adjusted models, treatment with papaverine hydrochloride was an independent favorable factor for improved functional visual acuity at discharge (odds ratio [OR] = 3.52, 95% confidence interval [CI]: 1.20–10.36, p = 0.022) and at the 1-month follow-up (OR = 3.15, 95% CI: 1.19–8.29, p = 0.020). Subgroup analyses demonstrated consistent therapeutic effects across age, sex, the side of the affected eye, intra-arterial thrombolysis and intravenous thrombolysis strata, with no statistically significant interaction effects identified at either time point (all Pinteraction >0.05). Conclusion Treatment with papaverine hydrochloride was significantly associated with visual recovery in patients with NA-CRAO. Prospective further studies of causality are needed to validate these results and assess their safety.