Efficacy of Intravenous Tissue-Type Plasminogen Activator in Central Retinal Artery Occlusion: Report From a Randomized, Controlled Trial

Celia Chen, Andrew Lee, Bruce Campbell, Tien Lee, Mark Paine, Clare Fraser, John Grigg, Romesh Markus

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    65 Citations (Scopus)

    Abstract

    Background and Purpose-Central retinal artery occlusion is caused by a platelet-fibrin thrombus or embolic occlusion and is a stroke of the eye. Observational studies suggest that thrombolytics may restore ocular perfusion and visual function. We hypothesized that intravenous tissue-type plasminogen activator (tPA) administered within 24 hours of symptom onset might restore ocular perfusion and visual function. Methods-A placebo-controlled, randomized trial of intravenous tPA versus intravenous saline was performed in patients with clinically defined central retinal artery occlusion within 24 hours of symptom onset. tPA was administered at a total dose of 0.9 mg/kg, with 10% given as a 1-minute bolus and the remainder over 1 hour. An improvement of visual acuity of 3 lines or more was considered significant. Results-Twenty-five percent (2 of 8) of the tPA group experienced the primary outcome at 1 week after tPA versus none of the placebo group. One patient had an intracranial hemorrhage. The visual acuity improvement of these 2 patients was not sustained at 6 months. In both patients, tPA was administered within 6 hours of symptom onset. Conclusions-Although essentially a negative study, it does add to the evidence base of reperfusion in central retinal artery occlusion by showing that the time window for intervention is likely to be <6 hours. Reocclusion is a potential problem and may require adjuvant anticoagulation. Future studies should concentrate on determining the efficacy of thrombolytics in the <6-hour time window. CLINICAL TRIAL REGISTRATION-: URL: http://www.anzctr. org.au. Unique identifier: 83102.

    Original languageEnglish
    Pages (from-to)2229-2234
    Number of pages6
    JournalStroke
    Volume42
    Issue number8
    DOIs
    Publication statusPublished - Aug 2011

    Keywords

    • ophthalmology
    • retinal ischemia
    • thrombolysis
    • thrombolytic agents
    • tPA

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