Local intra-arterial fibrinolysis for acute occlusion of the central retinal artery: a meta-analysis of the published data. Issue 8 (1st August 2000)

• Record Type: Journal Article
• Authors: Beatty, S; Eong, K G Au
• Is Part Of: British journal of ophthalmology. Volume 84:Issue 8(2000)
• Page Start: 914
• Page End: 916
• Publication Date: 2000-08-01
• Subjects: central retinal artery occlusion -- fibrinolysis -- streptokinase -- thrombolysis -- tissue plasminogen activator -- urokinase; Ophthalmology -- Periodicals; 617.7
• DOI: 10.1136/bjo.84.8.914
• Languages: English
• ISSNs: 0007-1161

Abstract

Abstract : BACKGROUND/AIM: Central retinal artery occlusion (CRAO) is typically associated with a poor visual outcome. Several favourable reports of local intra-arterial fibrinolysis (LIF), which involves the superselective administration of a thrombolytic agent directly into the ophthalmic artery, have appeared in the recent literature. The aim of this study was to critically appraise these studies in a collective fashion. METHODS: A meta-analysis was performed of all the published literature germane to LIF in cases of CRAO. RESULTS: Of the 16 studies identified, all were retrospective and non-randomised. After correction for data duplication, the results of LIF in 100 patients can be reported. A final acuity of 6/6 or better was seen in 14% of patients following LIF, and a visual result of 6/12 or better was seen in 27% of subjects. A poor final acuity of 3/60 or worse was seen in 60.6% of eyes treated with local intra-arterial fibrinolysis. These results compare favourably with conventional forms of therapy. Potentially serious complications were seen in four patients, but no patient suffered a permanent neurological deficit. CONCLUSION: The results of this study suggest that there may be a marginal visual benefit associated with LIF compared with conventional management of CRAO. However, the methodology of the cited studies was often unsatisfactory, and a randomised controlled trial of LIF in cases of CRAO is justified. Outside of a randomised clinical trial, the use of superselective fibrinolytic therapy for CRAO cannot be recommended on the basis of current evidence.