Ophthalmic artery branch retrograde interventional therapy for central retinal artery occlusion_Chinese Journal of Ocular Fundus Diseases

Authors：

 WangRunsheng ¹ , QianLu ² , WangYi ³ , ZhengYi ³ , DuShanshuang ¹ , LeiTao ² , LyuPeilin ¹ , WangWenjun ¹

1. Department of Ophthalmology, The Forth Hospital of Xi'an, Xi'an 710004, China;
2. Department Of Neurology, The Forth Hospital of Xi'an, Xi'an 710004, China;
3. Invasive Technology Department, The Forth Hospital of Xi'an, Xi'an 710004, China;

Corresponding author：

WangRunsheng, Email: wangrunsheng0602@sohu.com

Keywords：

Retinal artery occlusion/drug therapy; Thrombolytic therapy; Radiography,interventional; Angiography,digital subtraction; Fluorescein angiography

DOI：

10.3760/cma.j.issn.1005-1015.2016.04.008

Video：

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Objective To observe the clinical effect of the ophthalmic artery branch retrograde interventional therapy for central retinal artery occlusion (CRAO). Methods Fourteen CRAO patients (14 eyes) were enrolled in this study, including 8 males and 6 females. The age was ranged from 35 to 80 years old,with an average of (56.7±20.3) years. The duration of occurrence after the onset was 9 to 72 hours, with a mean of 22 hours. There were 4 eyes with vision of no light perception, 5 eyes with light perception and 5 eyes with hand movement. The intraocular pressure was ranged from 14-20 mmHg (1 mmHg=0.133 kPa), with an average of 19 mmHg. All the patients received the treatment of ophthalmic artery branch retrograde interventional therapy according to the indications and contraindications of thrombolytic therapy in acute cerebral infraction patients. Micro catheters was inserted into the exposed arteries from a skin incision below the eyebrow under guidance of digital subtraction angiography (DSA), urokinase (total 0.4 million U) and papaverine 30 mg were injected into the arteries. After artery thrombolysis, the changes of DSA, filling time of retinal artery and its branches on fluorescence fundus angiography (FFA) within 48 hours and the visual acuity were observed. According to the visual acuity of post-treatment and pre-treatment, the therapeutic effects on vision were defined as effective markedly (improving 3 lines or more), effective (improving 2 lines) and no effect (change within 1 line or a decline). According to the arm-retinal circulation time (A-Rct) and filling time of retinal artery and its branches (FT) on fluorescence fundus angiography (FFA), the therapeutic effects on retinal circulation were defined as effective markedly (A-Rct 15 s, FT 2 s), effective (A-Rct was improved but in the range of 16-20 s, FT was in 3-8 s) and no effect (A-Rct was improved but 21 s, FT 9 s). The follow up ranged from 5 to 21days, with a mean of 6 days. The related local or systemic complications were recorded. Results Ophthalmic arterial catheterization under DSA was successful in all 14 eyes. After intermittent injection of drugs, ophthalmic artery and internal carotid artery displayed good images in DSA. The results showed enlargement of ophthalmic artery and its branches after injection of thrombolytic drugs by micro catheters. The circulation time in ophthalmic artery is speed up for 2 s before thrombolysis in 5 eyes, 3 s in 6 eyes, and 4 s in 3 eyes. Within 48 hours after thrombolysis treatment, the filling time of retinal artery and its branches on FFA was significantly increased than that of before interventional therapy. The retinal circulation was effective markedly in 8 eyes (57.1%), effective in 4 eyes (28.6%) and no effect in 2 eyes (14.3%). The vision changes showed effective markedly in 6 eyes (42.9%), effective in 6 eyes (42.9%), no effect in 2 eyes (14.2%). There was no abnormal eye movements, vitreous hemorrhage and incision hematoma, intracranial hemorrhage, cerebral embolism, and other local and systemic adverse effectives during the follow-up. Conclusions The ophthalmic artery branch retrograde interventional therapy in the treatment for CRAO can improve retinal circulation and vision. And there is no related local or systemic complications.

Citation： WangRunsheng, QianLu, WangYi, ZhengYi, DuShanshuang, LeiTao, LyuPeilin, WangWenjun. Ophthalmic artery branch retrograde interventional therapy for central retinal artery occlusion. Chinese Journal of Ocular Fundus Diseases, 2016, 32(4): 377-381. doi: 10.3760/cma.j.issn.1005-1015.2016.04.008 Copy

1.	Beatty S,AU Eong KG.Local intra——arterial fibrinolysis for acute occlusion of the central retinal artery:a meta analysis of the published data[J].Br J Ophthalmol,2000,84(8):914-916.
2.	姜金利, 李宝民,马志忠,等.局部动脉内溶栓治疗视网膜中央动脉阻塞26例报告[J].解放军医学杂志,2004,29(4):356-357.Jiang JL, Li BM, Ma ZZ,et al. Selective intra-arterial thrombolytic therapy for central retinal artery occlusion:26 cases report[J]. Med J Chin PLA, 2004,29(4):356-357.
3.	姚勇, 沈晓文,吴又凯,等.超选插管灌注溶栓药治疗视网膜中央动脉阻塞[J].中华眼底病杂志,2005,21(1):16-19.Yao Y, Shen XW, Wu YK, et al. Thrombolysis infusion via microcatheter treating central retinal artery occlusion[J]. Chin J Ocul Fundus Dis, 2005, 21(1):16-19.
4.	赵喜庆, 孟祥靖,吉训明,等.经眼动脉超选插管溶栓治疗视网膜中央动脉阻塞[J].中华眼底病杂志,2005,21(1):22-24.Zhao XQ, Meng XJ, Ji XM, et al. Treatment of central retinal artery occlusion by thrombolysis via super-selective ophthalmic artery catheterization[J]. Chin J Ocul Fundus Dis, 2005, 21(1):22-24.
5.	丁宁, 赤克美,王虔,等.超选择眼动脉内溶栓治疗视网膜中央动脉阻塞[J].医师进修杂志,2005,28(19):51-52.DOI:10.3760/cma.j.issn.1673-4904.2005.19.021. Ding N,Chi KM,Wang Y, et al. Treatment of central retinal artery occlusion with super selective ophthalmic artery thrombolysis[J]. J Postgrad Med, 2005,28(19):51-52.DOI:10.3760/cma.j.issn.1673-4904.2005.19.021.
6.	翟文娟, 时冀川,王玉祥.视网膜中央动脉阻塞的颈内动脉造影检查和介入溶栓治疗[J].中华眼底病杂志,2005,21(1):20-21.Zhai WJ, Shi JC, Wang YX. Internal carotid artery angiography and interventional thrombolytic therapy for central retinal artery occlusion[J]. Chin J Ocul Fundus Dis, 2005, 21(1):20-21.
7.	王润生, 雷涛,王毅,等.超选择性眼动脉及选择性颈内动脉溶栓治疗视网膜中央动脉阻塞的疗效观察[J].中华眼底病杂志,2014, 30(5):450-453.DOI:10.3760/cma.j.issn.1005-1015.2014.05.005. Wang RS,Lei T,Wang Y,et al. Super-selective ophthalmic artery or selective carotid artery thrombolytic therapy for central retinal artery occlusion[J]. Chin J Ocul Fundus Dis,2014, 30(5):450-453.DOI:10.3760/cma.j.issn.1005-1015.2014.05.005.
8.	Mirshahi A, Feltgen N, Hansen LL,et al. Retinal vascular occlusions[J]. Dtsch Arztebl Int, 2008, 105(26):474-479. DOI:10.3238/arztebl.2008.0474.
9.	Biousse V. Thrombolysis for acute central retinal artery occlusion:is it time?[J]. Am J Ophthalmol, 2008, 146(5):631-634.DOI:10.1016/j.ajo.2008.07.025.
10.	王润生, 李官禄.眼动脉终末支逆行插管的应用解剖研究[J].中国局解手术学杂志,1999,8(4):245-248.Wang RS, Li GL. Applied anatomy of the retrograde catheterization of the ophthalmic artery[J]. Chin J Surg, 1999,8(4):245-248.
11.	王润生, 李官禄,王煊,等.犬眶下动脉终末支逆行插管导药入眼实验研究[J].眼科新进展,2000,20(4):255-256.Wang RS, Li GL, Wang X, et al. Experimental sturdy of retrograde catheterization and administration of drugs into eyes through the infraorbital arteries in dogs[J]. Rec Adv Ophthalmol, 2000,20(4):255-256.
12.	王志成. 我国眼动脉逆行灌注技术研究跻入世界先进行列[J].今日科技,1999,20(7):255-256.Wang ZC. China's Ophthalmic artery retrograde perfusion technique and the advanced ranks in the world[J]. Today, Science and Technology, 1999,20(7):255-256.
13.	王润生, 李官禄,王为农,等.眼动脉逆行药物灌注术临床小结[J].中国实用眼科杂志,2000,18(4):223-224.Wang RS, Li GL, Wang WN,et al. Clinical observation on operation of drugs perfusion retrograde into ophthalmol artery[J]. Chin J Pract Ophthalmol, 2000,18(4):223-224.
14.	罗树明, 汪凯.脑血管病[M]//贾建平.神经病学.北京:人民卫生出版社,2010:182-183.Luo SM, Wang K. Brain vascular disease of neurology[M]//Jia JP. Neurology. Beijing:People's Medical Publishing House,2010:182-183.
15.	王润生, 吕沛霖,王宾,等.视网膜中央动脉阻塞患者视网膜循环时间与中心视力损害的关系[J].中华眼底病杂志,2007,23(3):177-179.Wang RS, Lyu PL, Wang B, et al. Relationship between retinal circulation time and visual loss in patients with central retinal artery occlusion[J]. Chin J Ocul Fundus Dis, 2007, 23(3):177-179.
16.	Egan RA, Van Stavern R.Should patients with acute central retinal artery occlusions be treated with intra-arterial t-PA?[J]. J Neuroophthalmol, 2015, 35(2):205-209. DOI:10.1097/WNO.0000000000000231.
17.	周亮. 逆行性动脉内注射药物至眼动脉治疗眼病的新方法[J].国外医学参考眼科学分册,1978,2:89-90.Zhou L. New method of retrograde intra arterial injection of drugs to the ophthalmic artery for the treatment of ocular diseases[J]. Foreign Medical Reference Ophthalmic Sciences Fascicule, 1978,2:89-90.
18.	雷涛, 王润生,吕沛霖,等.缺血性脑血管病患者眼动脉及其主要分支的数字减影血管造影观察[J].中华眼底病杂志,2012,28(5):489-492.DOI:10.3760/cma.j.issn.1005-1015.2012.05.014. Lei T, Wang RS, Lyu PL, et al. Digital subtraction angiography characteristics of ophthalmic artery and its main branches in ischemic cerebrovascular disease[J]. Chin J Ocul Fundus Dis, 2012, 28(5):489-492.DOI:10.3760/cma.j.issn.1005-1015.2012.05.014.

1. Beatty S,AU Eong KG.Local intra——arterial fibrinolysis for acute occlusion of the central retinal artery:a meta analysis of the published data[J].Br J Ophthalmol,2000,84(8):914-916.
2. 姜金利, 李宝民,马志忠,等.局部动脉内溶栓治疗视网膜中央动脉阻塞26例报告[J].解放军医学杂志,2004,29(4):356-357.Jiang JL, Li BM, Ma ZZ,et al. Selective intra-arterial thrombolytic therapy for central retinal artery occlusion:26 cases report[J]. Med J Chin PLA, 2004,29(4):356-357.
3. 姚勇, 沈晓文,吴又凯,等.超选插管灌注溶栓药治疗视网膜中央动脉阻塞[J].中华眼底病杂志,2005,21(1):16-19.Yao Y, Shen XW, Wu YK, et al. Thrombolysis infusion via microcatheter treating central retinal artery occlusion[J]. Chin J Ocul Fundus Dis, 2005, 21(1):16-19.
4. 赵喜庆, 孟祥靖,吉训明,等.经眼动脉超选插管溶栓治疗视网膜中央动脉阻塞[J].中华眼底病杂志,2005,21(1):22-24.Zhao XQ, Meng XJ, Ji XM, et al. Treatment of central retinal artery occlusion by thrombolysis via super-selective ophthalmic artery catheterization[J]. Chin J Ocul Fundus Dis, 2005, 21(1):22-24.
5. 丁宁, 赤克美,王虔,等.超选择眼动脉内溶栓治疗视网膜中央动脉阻塞[J].医师进修杂志,2005,28(19):51-52.DOI:10.3760/cma.j.issn.1673-4904.2005.19.021. Ding N,Chi KM,Wang Y, et al. Treatment of central retinal artery occlusion with super selective ophthalmic artery thrombolysis[J]. J Postgrad Med, 2005,28(19):51-52.DOI:10.3760/cma.j.issn.1673-4904.2005.19.021.
6. 翟文娟, 时冀川,王玉祥.视网膜中央动脉阻塞的颈内动脉造影检查和介入溶栓治疗[J].中华眼底病杂志,2005,21(1):20-21.Zhai WJ, Shi JC, Wang YX. Internal carotid artery angiography and interventional thrombolytic therapy for central retinal artery occlusion[J]. Chin J Ocul Fundus Dis, 2005, 21(1):20-21.
7. 王润生, 雷涛,王毅,等.超选择性眼动脉及选择性颈内动脉溶栓治疗视网膜中央动脉阻塞的疗效观察[J].中华眼底病杂志,2014, 30(5):450-453.DOI:10.3760/cma.j.issn.1005-1015.2014.05.005. Wang RS,Lei T,Wang Y,et al. Super-selective ophthalmic artery or selective carotid artery thrombolytic therapy for central retinal artery occlusion[J]. Chin J Ocul Fundus Dis,2014, 30(5):450-453.DOI:10.3760/cma.j.issn.1005-1015.2014.05.005.
8. Mirshahi A, Feltgen N, Hansen LL,et al. Retinal vascular occlusions[J]. Dtsch Arztebl Int, 2008, 105(26):474-479. DOI:10.3238/arztebl.2008.0474.
9. Biousse V. Thrombolysis for acute central retinal artery occlusion:is it time?[J]. Am J Ophthalmol, 2008, 146(5):631-634.DOI:10.1016/j.ajo.2008.07.025.
10. 王润生, 李官禄.眼动脉终末支逆行插管的应用解剖研究[J].中国局解手术学杂志,1999,8(4):245-248.Wang RS, Li GL. Applied anatomy of the retrograde catheterization of the ophthalmic artery[J]. Chin J Surg, 1999,8(4):245-248.
11. 王润生, 李官禄,王煊,等.犬眶下动脉终末支逆行插管导药入眼实验研究[J].眼科新进展,2000,20(4):255-256.Wang RS, Li GL, Wang X, et al. Experimental sturdy of retrograde catheterization and administration of drugs into eyes through the infraorbital arteries in dogs[J]. Rec Adv Ophthalmol, 2000,20(4):255-256.
12. 王志成. 我国眼动脉逆行灌注技术研究跻入世界先进行列[J].今日科技,1999,20(7):255-256.Wang ZC. China's Ophthalmic artery retrograde perfusion technique and the advanced ranks in the world[J]. Today, Science and Technology, 1999,20(7):255-256.
13. 王润生, 李官禄,王为农,等.眼动脉逆行药物灌注术临床小结[J].中国实用眼科杂志,2000,18(4):223-224.Wang RS, Li GL, Wang WN,et al. Clinical observation on operation of drugs perfusion retrograde into ophthalmol artery[J]. Chin J Pract Ophthalmol, 2000,18(4):223-224.
14. 罗树明, 汪凯.脑血管病[M]//贾建平.神经病学.北京:人民卫生出版社,2010:182-183.Luo SM, Wang K. Brain vascular disease of neurology[M]//Jia JP. Neurology. Beijing:People's Medical Publishing House,2010:182-183.
15. 王润生, 吕沛霖,王宾,等.视网膜中央动脉阻塞患者视网膜循环时间与中心视力损害的关系[J].中华眼底病杂志,2007,23(3):177-179.Wang RS, Lyu PL, Wang B, et al. Relationship between retinal circulation time and visual loss in patients with central retinal artery occlusion[J]. Chin J Ocul Fundus Dis, 2007, 23(3):177-179.
16. Egan RA, Van Stavern R.Should patients with acute central retinal artery occlusions be treated with intra-arterial t-PA?[J]. J Neuroophthalmol, 2015, 35(2):205-209. DOI:10.1097/WNO.0000000000000231.
17. 周亮. 逆行性动脉内注射药物至眼动脉治疗眼病的新方法[J].国外医学参考眼科学分册,1978,2:89-90.Zhou L. New method of retrograde intra arterial injection of drugs to the ophthalmic artery for the treatment of ocular diseases[J]. Foreign Medical Reference Ophthalmic Sciences Fascicule, 1978,2:89-90.
18. 雷涛, 王润生,吕沛霖,等.缺血性脑血管病患者眼动脉及其主要分支的数字减影血管造影观察[J].中华眼底病杂志,2012,28(5):489-492.DOI:10.3760/cma.j.issn.1005-1015.2012.05.014. Lei T, Wang RS, Lyu PL, et al. Digital subtraction angiography characteristics of ophthalmic artery and its main branches in ischemic cerebrovascular disease[J]. Chin J Ocul Fundus Dis, 2012, 28(5):489-492.DOI:10.3760/cma.j.issn.1005-1015.2012.05.014.

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