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Clot busting in situ may be best for treating a blocked central retinal artery

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Intra-arterial thrombolysis (IAT) may be a better way of restoring vision in patients with sudden blockage of the central retinal artery in future, if promising results from an initial study are confirmed by randomised control trial.

Patients having IAT with urokinase in the retrospective case-control study had a better chance of improved visual acuity, with more attaining a final visual acuity of >0.6 than those having conventional treatment (22% v 0%). Both patient groups were well matched. Younger age was the only significant attribute linked to improved vision, but the researchers are reluctant to use this to select for treatment as improvement did occur in some older some patients and because the condition has such a poor prognosis generally. Six patients had adverse events: cerebrovascular ischaemia, transient ischaemic attacks, and a stroke, promptly located and treated with urokinase.

The study compared 37 patients having IAT with urokinase to disperse a clot in a central retinal artery within six hours after the event with 19 patients who received conventional treatment—aspirin or heparin with anterior chamber paracentesis or acetazolamide, or both—because of unavailability of IAT or unfavourable circumstances. Eyesight was assessed by standard measurement within 48 hours afterwards and 2–8 weeks later.

Several case series and a recent meta-analysis have indicated that IAT may be a promising treatment, but because of haemorrhagic or ischaemic complications the researchers caution that the procedure should be performed by a neuroradiologist familiar with doing it in vessels within the brain too.