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Study findings inconclusive for central retinal artery occlusion treatment

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Andrew P. Schachat

KAANAPALI, Hawaii — Treatment recommendations for central retinal artery occlusion continue to vary, and the few randomized, clinical trials that do exist have yet to show much benefit, according to a presenter here.

"Central retinal artery occlusion is a difficult disease for which to have a randomized clinical trial," said Andrew P. Schachat, MD, who presented results from the EAGLE study (European assessment group for lysis in the eye), at Retina 2011. "You need neuroradiology perfusionists and other special expertise for abrupt and acute treatment of stroke available and ready to treat these patients within a couple of hours."

Patients from the EAGLE study (n = 82) were separated into conservative standard treatment and local intra-arterial fibrinolysis treatment groups. Both groups received low-dose heparin and aspirin; medical workup included transesophageal echocardiography and carotid duplex ultrasound. The efficacy endpoint was change in vision after 1 month; however, the study was ultimately halted early due to safety concerns, as three patients experienced serious adverse events within the first 24 hours of the study.

The EAGLE study's efficacy results appeared similar to those of previous studies, and the trial may not have needed to be stopped early had the patient population been larger, according to Dr. Schachat.

"What I would remember about artery occlusion is if there is no plaque, there have been a number of good studies showing mortality is pretty similar to age-matched controls," Dr. Schachat said. "[However], if there is plaque, the relative risk for mortality in a few studies is two- or three-fold. Those patients merit referral to a vascular specialist or a neurologist, who can manage for stroke and other conditions that they are at greater risk for."

• Disclosure: Dr. Schachat has no relevant financial interest to disclose.

Hawaiian Eye and Retina 2012 will be held January 15-20 at the Grand Wailea Resort & Spa in Maui. Learn more at OSNHawaiianEye.com or RetinaMeeting.com.