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Intra-Arterial Thrombolysis for Central Retinal Artery Occlusion

Authors Hakim N, Hakim J

Received 13 October 2019

Accepted for publication 19 November 2019

Published 13 December 2019 Volume 2019:13 Pages 2489—2509


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 2

Editor who approved publication: Dr Scott Fraser

Navid Hakim,1 Jamil Hakim2

1St. Pauls Eye Department, Royal Liverpool Hospital, Liverpool, UK; 2Ophthalmology Department, Queen Mary’s Hospital Sidcup, Sidcup, UK

Correspondence: Navid Hakim
St. Pauls Eye Department Royal Liverpool Hospital Prescot St, Liverpool L7 8XP, UK
Tel +07540492816

Introduction: Central retinal artery occlusion is an ophthalmic emergency which typically causes acute, painless visual loss. Several conservative treatment options are practiced with little benefit. Thrombolysis as a therapeutic option has gathered interest as well as controversy. This paper aims at reviewing the relevant literature to assess the efficacy and safety of intra-arterial thrombolysis for acute central retinal artery occlusion.
Methods: A review of the literature was conducted. Keywords included “intra-arterial thrombolysis” or “intra-arterial fibrinolysis” in combination with “central retinal artery occlusion” or “CRAO”. A Cochrane Database search was performed for randomised control trials, systematic reviews and meta-analyses using the same keywords.
Results: Twenty-eight studies were identified which included case reports, case series, case-control studies and 1 randomised control trial: the European Assessment Group for Lysis in the Eye Study. Improvement in vision was measured using different methods and at different time points. The findings of these studies generally favour an effect towards intra-arterial thrombolysis however there are many limitations. Additionally, the European Assessment Group for Lysis in the Eye Study showed lack of effect in intra-arterial thrombolysis vs conservative measures.
Conclusion: Current evidence is not sufficient to recommend intra-arterial thrombolysis due to the variability of visual improvement within retrospective studies, heterogeneity in treatment regimens between studies and adverse effects. Intra-arterial thrombolysis may have a role in patients presenting early, particularly if they have monocular vision, after discussion of the risks and benefits. Further high-quality trials assessing the clinical efficacy of intra-arterial thrombolysis may shed more light on this topic.

Keywords: central retinal artery occlusion, intra-arterial, thrombolysis, fibrinolysis

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