Intra-arterial fibrinolysis yields visual improvement in patients with central retinal artery occlusion

Administering local intra-arterial fibrinolysis in aliquots to patients with acute central retinal artery occlusion appears to improve visual acuity with fewer side effects than standard therapy, according to a study.

Eric M. Aldrich, MD, PhD, and colleagues at Johns Hopkins Hospital compared visual outcomes for 42 patients with acute central retinal artery occlusion of presumed thromboembolic etiology after administering either local intra-arterial fibrinolysis in aliquots or standard occlusion therapy. Specifically, 21 patients received local intra-arterial fibrinolysis and 21 patients received standard treatment.

A total of 76% patients in the local intra-arterial fibrinolysis group had achieved a visual acuity improvement of one line or more compared with 33% in the standard therapy group (P = .012), the authors noted.

After controlling for gender, history of prior stroke and transient ischemic attack, and history of hypercholesterolemia, multivariate logistic regression analysis revealed that patients who received tissue plasminogen activator were 36 times more likely to have improvement in visual acuity (P = .0001).

"Post hoc analysis showed that patients who received tissue plasminogen activator were 13 times more likely to have improvement in visual acuity of three lines or more (P = .03) and 4.9 times more likely to have a final visual acuity of 20/200 or better (P =0.04)," the study authors said.

They reported two groin hematomas in the local intra-arterial fibrinolysis group; no ischemic strokes, retinal hemorrhages or intracerebral hemorrhages were reported, according to the study, published in the June issue of Stroke.