Super-selective ophthalmic artery or selective carotid artery thrombolytic therapy for central retinal artery occlusion_Chinese Journal of Ocular Fundus Diseases

Authors：

 WangRunsheng , LeiTao , WangYi , 吕沛霖 , 雷晓琴 , 杜善双

Department of Ophthalmology, 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; Urinary plasminogen activator/therapeutic use

DOI：

10.3760/cma.j.issn.1005-1015.2014.05.005

Video：

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Objective To observe the clinical effect of super-selective ophthalmic artery or selective carotid artery thrombolytic therapy for central retinal artery occlusion (CRAO). Methods Twelve CRAO patients (12 eyes) were enrolled in this study. The patients included 7 males and 5 females. The age was ranged from 19 to 68 years old, with an average of (50.0±3.5) years. The disease duration was from 8 to 72 hours, with a mean of 18 hours. All the patients were received the treatment of super-selective ophthalmic artery or selective carotid artery thrombolysis with urokinase (total 0.20-0.4 million U) and injection of papaverine 30 mg. Five patients received the treatment of super-selective ophthalmic artery thrombolytic therapy, 7 patients received the treatment of selective carotid artery thrombolytic therapy (4 patients because of the financial issues, 3 patients because of thin ophthalmic artery). According to the visual acuity of post-treatment and pre-treatment, the therapeutic effects on vision were defined as effective markedly (improving three lines or more), effective (improving two lines) and no effect (no change 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). Results The vision changes showed effective markedly in 5 eyes (41.7%), effective in 5 eyes (41.7%), no effect in 2 eyes (16.6%). The total therapeutic efficiency on vision was 83.4%. The retinal circulation was improved in all eyes after treatment, including effective markedly in 8 eyes (67.0%), effective in 4 eyes (33.0%). The total therapeutic efficiency on retinal circulation was 100.0%. No complications occurred in these 12 patients during the treatment or follow-up, such as puncture site hematoma, intracranial hemorrhage, cerebral embolism, eye movement abnormalities, retinal and vitreous hemorrhage. Conclusion Super-selective ophthalmic artery and selective carotid artery thrombolytic therapy were effective in the treatment of CRAO.

Citation： WangRunsheng, LeiTao, WangYi. Super-selective ophthalmic artery or selective carotid artery thrombolytic therapy for central retinal artery occlusion. Chinese Journal of Ocular Fundus Diseases, 2014, 30(5): 450-453. doi: 10.3760/cma.j.issn.1005-1015.2014.05.005 Copy

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10.	Vulpius K, HÖh H, Lange H, et al. Selective percutaneous transluminal thrombolytic therapy with rt-PA in central retinal artery occlusion[J]. Ophthalmologe,1996,93:149-153.
11.	Johannes W, Luca R, Heinrich P, et al. Selective intra-arterial fibrinolysis of acute central retinal artery occlusion[J]. Stroke, 1998, 29:2076-2079.
12.	吕秋真,曹淑芹,李秋婷. 尿激酶颈内动脉注射溶栓治疗视网膜中央动脉阻塞6例[J]. 眼科,2002,11:210.

1. 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,2012,28:489-492.
2. 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,2005,21:20-21.
3. Hayreh SS,Zimmerman MB.Central retinal artery occlusion:visual outcome[J].Am J Ophthalmol,2005,140:376-391.
4. 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.
5. 王润生,吕沛霖,张娅萍,等.以尿激酶静脉溶栓为主治疗视网膜中央动脉阻塞115例临床观察[J].中华眼底病杂志,2012,28:466-471.
6. Cugati S, Varma DD, Chen CS, et al. Treatment options for central retinal artery occlusion[J].Curr Treat Options Neurol, 2013,15:63-77.
7. Beatty S, Au Eong KG. Acute occlusion of the retinal arteries:current concepts and recent advances in diagnosis and management[J]. Accid Emerg Med, 2000, 17:324-329.
8. 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, 23:177-179.
9. 赵云辉, 马著彬, 庄磊, 等. 单侧和双侧颈内动脉狭窄或闭塞侧支循环途径的研究[J]. 影像诊断与介入放射学杂志, 2006, 15:155-158.
10. Vulpius K, HÖh H, Lange H, et al. Selective percutaneous transluminal thrombolytic therapy with rt-PA in central retinal artery occlusion[J]. Ophthalmologe,1996,93:149-153.
11. Johannes W, Luca R, Heinrich P, et al. Selective intra-arterial fibrinolysis of acute central retinal artery occlusion[J]. Stroke, 1998, 29:2076-2079.
12. 吕秋真,曹淑芹,李秋婷. 尿激酶颈内动脉注射溶栓治疗视网膜中央动脉阻塞6例[J]. 眼科,2002,11:210.

Chinese Journal of Ocular Fundus Diseases

Super-selective ophthalmic artery or selective carotid artery thrombolytic therapy for central retinal artery occlusion

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