K 280Intra-arterial fibrinolysis in the treatment of central artery occlusion
C. Framme, D. Spiegel, H. G. Sachs, C. P. Lohmann, J. Roider
Background: Conventional treatment of a retinal central artery occlusion usually has a poor prognosis. Another treatment option is the intra-arterial fibrinolysis of the arteria ophthalmica. The importance of the fibrinolysis was evaluated retrospectively in 62 eyes with central artery occlusion in our own patients collective.
Material and methods: Over a period of five years the patients charts of 62 eyes were analyzed and both groups of patients treatment with intra-arterial fibrinolysis (n=17) and conventional treatement (decrease of IOP, improvement of rheologic conditions; n=45) were compared. Patients were ruled out for fibrinolysis therapy if they presented later than eight hours after the occlusion appeared or if they had history for hemorrhages, previous operations or if they were very rather old. Intra-arterial fibrinolysis was performed using either urokinase or tPA.
Results: Out of 62 eyes with a central retinal artery occlusion 24 eyes (39%) underwent catheterization but in seven of these eyes an arterial stenosis did not allow fibrinolysis. The remaining 17 eyes underwent successful fibrinolysis. In 38 eyes (61%) no fibrinolysis was indicated primarily. From these patients 45% (17/38) were too late in clinic, 18% (7/38) did not agree with fibrinolysis, 15% (6/38) presented with medical contraindications for fibrinolysis and 13% (5/38) were too old. In 8% (3/17) no fibrinolyis was performed because of an intact cilioretinal anastomosis preserving a moderate visual acuity in two cases and because of a spontaneous recovery of visual acuity during examination in another patient. In the fibrinolysis group 29% (5/17) showed improvement of visual acuity more than two lines, 53% (9/17) were stable and 18% (3/17) had decreased visual acuity more than two lines after treatment. In the conservatively treated group an improvement of visual acuity was observed in 31% (14/45), no change in 67% (30/45) and a decrease in 2% (1/45). In three patients of the fibrinolysis group (18%; 3/17) an acute hemiplegia occured during treatment, which was stopped immediately. During one week a total recovery was noticed in two of these patients.
Conclusion: In summary a lot of patients were too late in clinic for fibrinolysis. Further more our evaluation showed that there was no statistical difference between the fibrinolysis group and the conventional treatment group concerning the improvement of visual acuity. Because there is a general risk of apoplexia during fibrinolysis the treatment options have to be discussed very carefully with each patient.
University Eye Hospital, Franz-Josef-Strauss-Allee 11, D-93042 Regensburg