Intra-arterial thrombolysis for central retinal artery occlusion: a systematic review
- 1Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Canada
- 2Faculty of Medicine, University of Ottawa, Ottawa, Canada
- 3Department of Radiology and Diagnostic Medical Imaging, University of Toronto, Toronto, Canada
- 4Sunnybrook Health Sciences Centre, Toronto, Canada
- Dr J Noble, Toronto Western Hospital, 399 Bathurst St, Rm 7E-401, Toronto, ON, Canada, M5T 2S8;
- Accepted 3 February 2008
Introduction: This review provides an updated analysis of the evidence supporting intra-arterial thrombolysis (IAT) for the treatment of central retinal artery occlusion (CRAO).
Methods: A systemic review of the literature indexed by Ovid MEDLINE was performed for the following medical subject headings: central retinal artery occlusion, thrombolysis, intra-arterial, fibrinolysis. Studies were analysed individually and categorised by study type, and extracted data grouped together for statistical analysis. Only studies with five patients or more were included in the review.
Results: Twenty-three studies were identified in the original search; eight were selected for the analysis. Of these studies, 158 patients were represented, in which treatment was instituted within an average of 8.4 (SD 4) h of symptom onset. In these patients, visual improvement occurred on average in 93% of patients, with 13% achieving 20/20 or better, 25% achieving 20/40 or better, and 41% achieving 20/200 or better. Complications occurred in 4.5% of cases.
Conclusion: IAT may produce superior visual outcomes compared with conventional treatments for CRAO when instituted in certain situations. At the moment, there is insufficient evidence to support the routine use of IAT to treat CRAO. Well-designed prospective, randomised trials remain to be done.
See Editorial, p 585
JN and NW contributed equally.
Competing interests: None.