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Efficacy and safety of intra-arterial thrombolysis in patients with central retinal artery occlusion: a systematic review and meta-analysis

  • Retinal Disorders
  • Published:
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Abstract

Purpose

To investigate the efficacy and safety of intra-arterial thrombolysis (IAT) in patients with central retinal artery occlusion (CRAO).

Methods

PubMed and EMBASE were searched for potentially eligible studies that reported IAT in CRAO patients from inception to Nov 8, 2021. Standard mean difference (SMD) was pooled to compare visual acuity (VA) at baseline with final in IAT patients. The rates and odds ratios (OR) were meta-analyzed to compare VA improvement in IAT with non-IAT patients, stratified to different times from onset to procedure, different definitions of VA improvement, and three CRAO stages. Adverse effects were recorded.

Results

Fifteen studies were included, enrolling 507 CRAO patients who received IAT and 296 CRAO patients who did not. VA was significantly improved from baseline to final VA in IAT patients (SMD [LogMAR] 0.70, 95% CI [0.51, 0.90]). VA improvement rate was higher in IAT patients than that in non-IAT (56% vs 32%, OR 3.55, 95%CI [1.74, 7.24]), with greater OR in IAT within 6 h from onset to procedure (OR 4.60, 95%CI [1.24, 16.99]) than that beyond 6 h (OR 3.36, 95%CI [1.43, 7.85]). The benefit remained consistent when VA improvement was defined as ≥ 3 lines on the Snellen chart (OR 4.68, 95%CI [2.10, 10.41]) and was even greater when CRAO was incomplete. Five patients had a symptomatic intracranial hemorrhage and 21 patients had ischemic stroke or transient ischemic attack after IAT.

Conclusions

IAT treatment has certain potential in ameliorating VA in CRAO patients, which should be balanced against cerebral complications.

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Abbreviations

CI:

Confidence interval

CRAO:

Central retinal artery occlusion

IAT:

Intra-arterial thrombolysis

ICH:

Intracranial hemorrhage

IVT:

Intravenous thrombolysis

MD:

Mean difference

OR:

Odds ratio

SMD:

Standard mean difference

VA:

Visual acuity

References

  1. Leavitt JA, Larson TA, Hodge DO, Gullerud RE (2011) The incidence of central retinal artery occlusion in Olmsted County, Minnesota. Am J Ophthalmol 152:820–823. https://doi.org/10.1016/j.ajo.2011.05.005

    Article  Google Scholar 

  2. Park SJ, Choi NK, Seo KH, Park KH, Woo SJ (2014) Nationwide incidence of clinically diagnosed central retinal artery occlusion in Korea, 2008 to 2011. Ophthalmology 121:1933–1938. https://doi.org/10.1016/j.ophtha.2014.04.029

    Article  Google Scholar 

  3. Kido A, Tamura H, Ikeda HO, Miyake M, Hiragi S, Tsujikawa A (2020) Nationwide incidence of central retinal artery occlusion in Japan: an exploratory descriptive study using the National Database of Health Insurance Claims (2011–2015). BMJ Open 24(10):e041104. https://doi.org/10.1136/bmjopen-2020-041104

    Article  Google Scholar 

  4. Pick J, Nickels S, Saalmann F, Finger RP, Schuster AK (2020) Incidence of retinal artery occlusion in Germany. Acta Ophthalmol 2020. https://doi.org/10.1111/aos.14369. Epub ahead of print

  5. Mac Grory B, Lavin P, Kirshner H, Schrag M (2020) Thrombolytic therapy for acute central retinal artery occlusion. Stroke 51:687–695. https://doi.org/10.1161/STROKEAHA.119.027478

    Article  Google Scholar 

  6. Schrag M, Youn T, Schindler J, Kirshner H, Greer D (2015) Intravenous fibrinolytic therapy in central retinal artery occlusion: a patient-level meta-analysis. JAMA Neurol 72:1148–1154. https://doi.org/10.1001/jamaneurol.2015.1578

    Article  Google Scholar 

  7. Dumitrascu OM, Newman NJ, Biousse V (2020) Thrombolysis for central retinal artery occlusion in 2020: time is vision! J Neuroophthalmol 40:333–345. https://doi.org/10.1097/WNO.0000000000001027

    Article  Google Scholar 

  8. Mac Grory B, Schrag M, Biousse V et al (2021) Management of central retinal artery occlusion: a scientific statement from the American Heart Association. Stroke 52:e282–e294. https://doi.org/10.1161/STR.0000000000000366

    Article  Google Scholar 

  9. Flaxel CJ, Adelman RA, Bailey ST et al (2020) Retinal and ophthalmic artery occlusions preferred practice pattern®. Ophthalmology 127:259–287. https://doi.org/10.1016/j.ophtha.2019.09.028

    Article  Google Scholar 

  10. Huang L, Wang Y, Zhang R (2021) Intravenous thrombolysis in patients with central retinal artery occlusion: a systematic review and meta-analysis. J Neurol. https://doi.org/10.1007/s00415-021-10838-6. Epub ahead of print. PMID: 34625849

  11. Mac Grory B, Nackenoff A, Poli S et al (2020) Intravenous fibrinolysis for central retinal artery occlusion: a cohort study and updated patient-level meta-analysis. Stroke 51:2018–2025. https://doi.org/10.1161/STROKEAHA.119.028743

    Article  Google Scholar 

  12. Beatty S, Au Eong KG (2000) Local intra-arterial fibrinolysis for acute occlusion of the central retinal artery: a meta-analysis of the published data. Br J Ophthalmol 84:914–916. https://doi.org/10.1136/bjo.84.8.914

    Article  CAS  Google Scholar 

  13. Schumacher M, Schmidt D, Jurklies B et al (2010) Central retinal artery occlusion: local intra-arterial fibrinolysis versus conservative treatment, a multicenter randomized trial. Ophthalmology 117:1367–1375. https://doi.org/10.1016/j.ophtha.2010.03.061

    Article  Google Scholar 

  14. Page PS, Khattar NK, White AC et al (2018) Intra-arterial thrombolysis for acute central retinal artery occlusion: a systematic review and meta-analysis. Front Neurol 9:76. https://doi.org/10.3389/fneur.2018.00076

    Article  Google Scholar 

  15. Shamseer L, Moher D, Clarke M et al (2015) Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015: elaboration and explanation. BMJ 350:g7647. https://doi.org/10.1136/bmj.g7647

    Article  Google Scholar 

  16. Stang A (2010) Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol 25:603–605. https://doi.org/10.1007/s10654-010-9491-z

    Article  Google Scholar 

  17. Ahn SJ, Kim JM, Hong JH et al (2013) Efficacy and safety of intra-arterial thrombolysis in central retinal artery occlusion. Invest Ophthalmol Vis Sci 54:7746–7755. https://doi.org/10.1167/iovs.13-12952

    Article  CAS  Google Scholar 

  18. Aldrich EM, Lee AW, Chen CS et al (2008) Local intraarterial fibrinolysis administered in aliquots for the treatment of central retinal artery occlusion: the Johns Hopkins Hospital experience. Stroke 39:1746–1750. https://doi.org/10.1161/STROKEAHA.107.505404

    Article  Google Scholar 

  19. Arnold M, Koerner U, Remonda L et al (2005) Comparison of intra-arterial thrombolysis with conventional treatment in patients with acute central retinal artery occlusion. J Neurol Neurosurg Psychiatry 76:196–199. https://doi.org/10.1136/jnnp.2004.037135

    Article  CAS  Google Scholar 

  20. Butz B, Strotzer M, Manke C, Roider J, Link J, Lenhart M (2003) Selective intraarterial fibrinolysis of acute central retinal artery occlusion. Acta Radiol 44:680–684. https://doi.org/10.1046/j.1600-0455.2003.00147.x

    Article  CAS  Google Scholar 

  21. Ko SJ, Shin IC, Kim DW, Choi SS, Yang YS (2021) Safety and efficacy of selective intra-arterial thrombolysis for central retinal artery occlusion. Korean J Ophthalmol 35:261–271. https://doi.org/10.3341/kjo.2020.0082

    Article  Google Scholar 

  22. Mercier J, Kastler A, Jean B et al (2015) Interest of local intra-arterial fibrinolysis in acute central retinal artery occlusion: clinical experience in 16 patients. J Neuroradiol 42:229–235. https://doi.org/10.1016/j.neurad.2014.02.007

    Article  Google Scholar 

  23. Pettersen JA, Hill MD, Demchuk AM et al (2005) Intra-arterial thrombolysis for retinal artery occlusion: the Calgary experience. Can J Neurol Sci 32:507–511. https://doi.org/10.1017/S0317167100004522

    Article  CAS  Google Scholar 

  24. Richard G, Lerche RC, Knospe V, Zeumer H (1999) Treatment of retinal arterial occlusion with local fibrinolysis using recombinant tissue plasminogen activator. Ophthalmology 106:768–773. https://doi.org/10.1016/S0161-6420(99)90165-3

    Article  CAS  Google Scholar 

  25. Schmidt DP, Schulte-Mönting J, Schumacher M (2002) Prognosis of central retinal artery occlusion: local intraarterial fibrinolysis versus conservative treatment. AJNR Am J Neuroradiol 23:1301–1307

    Google Scholar 

  26. Schumacher M, Schmidt D, Wakhloo AK (1993) Intra-arterial fibrinolytic therapy in central retinal artery occlusion. Neuroradiology 35:600–605. https://doi.org/10.1007/BF00588405

    Article  CAS  Google Scholar 

  27. Sobol EK, Sakai Y, Wheelwright D et al (2021) Intra-arterial tissue plasminogen activator for central retinal artery occlusion. Clin Ophthalmol 15:601–608. https://doi.org/10.2147/OPTH.S272126

    Article  Google Scholar 

  28. Wang R, Qian L, Wang Y et al (2017) Evaluation of ophthalmic artery branch retrograde intervention in the treatment of central retinal artery occlusion (CRAO). Med Sci Monit 23:114–120. https://doi.org/10.12659/msm.898352

    Article  CAS  Google Scholar 

  29. Weber J, Remonda L, Mattle HP et al (1998) Selective intra-arterial fibrinolysis of acute central retinal artery occlusion. Stroke 29:2076–2079. https://doi.org/10.1161/01.str.29.10.2076

    Article  CAS  Google Scholar 

  30. Zhang X, Ji X, Luo Y et al (2009) Intra-arterial thrombolysis for acute central retinal artery occlusion. Neurol Res 31:385–389. https://doi.org/10.1179/174313209X444008

    Article  CAS  Google Scholar 

  31. Hayreh SS (2011) Acute retinal arterial occlusive disorders. Prog Retin Eye Res 30:359–394. https://doi.org/10.1016/j.preteyeres.2011.05.001

    Article  Google Scholar 

  32. Hakim N, Hakim J (2019) Intra-arterial thrombolysis for central retinal artery occlusion. Clin Ophthalmol 13:2489–2509. https://doi.org/10.2147/OPTH.S232560

    Article  CAS  Google Scholar 

  33. Babikian V, Wijman CA, Koleini B, Malik SN, Goyal N, Matjucha IC (2001) Retinal ischemia and embolism. Etiologies and outcomes based on a prospective study. Cerebrovasc Dis 12:108–113. https://doi.org/10.1159/000047689

    Article  CAS  Google Scholar 

  34. Hayreh SS, Zimmerman MB, Kimura A, Sanon A (2004) Central retinal artery occlusion. Retinal survival time Exp Eye Res 78:723–736. https://doi.org/10.1016/s0014-4835(03)00214-8

    Article  CAS  Google Scholar 

  35. Tobalem S, Schutz JS, Chronopoulos A (2018) Central retinal artery occlusion - rethinking retinal survival time. BMC Ophthalmol 18:101. https://doi.org/10.1186/s12886-018-0768-4

    Article  Google Scholar 

  36. Pielen A, Pantenburg S, Schmoor C et al (2015) Predictors of prognosis and treatment outcome in central retinal artery occlusion: local intra-arterial fibrinolysis vs. conservative treatment. Neuroradiology 57:1055–1062. https://doi.org/10.1007/s00234-015-1588-3

    Article  Google Scholar 

  37. Hayreh SS (2007) Comment re: multicenter study of the European Assessment Group for Lysis in the Eye (EAGLE) for the treatment of central retinal artery occlusion: design issues and implications. Graefes Arch Clin Exp Ophthalmol 245:464–466; author reply 467–470. https://doi.org/10.1007/s00417-006-0473-5

  38. Youn TS, Lavin P, Patrylo M et al (2017) Current treatment of central retinal artery occlusion: a national survey. J Neurol 265:330–335. https://doi.org/10.1007/s00415-017-8702-x

    Article  Google Scholar 

  39. Schorr EM, Rossi KC, Stein LK, Park BL, Tuhrim S, Dhamoon MS (2020) Characteristics and outcomes of retinal artery occlusion: nationally representative data. Stroke 51:800–807. https://doi.org/10.1161/STROKEAHA.119.027034

    Article  Google Scholar 

  40. Casagrande M, Kromer R, Wenzel DA et al (2021) Determination of ischemia onset based on automatically generated spectralis SD-OCT values in acute central retinal artery occlusion. J Ophthalmol 2021:5527292. https://doi.org/10.1155/2021/5527292

    Article  Google Scholar 

  41. Mac Grory B, Schrag M, Poli S et al (2021) Structural and functional imaging of the retina in central retinal artery occlusion - current approaches and future directions. J Stroke Cerebrovasc Dis 30:105828. https://doi.org/10.1016/j.jstrokecerebrovasdis.2021.105828

    Article  Google Scholar 

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Author information

Authors and Affiliations

  1. Department of Ophthalmology, The First Affiliated Hospital of China Medical University, 155 Nanjingbei Street, Heping District, Shenyang, 110001, People’s Republic of China

    Lele Huang & Ruijun Zhang

  2. Department of Neurology, People’s Hospital of Liaoning Province, 33 Wenyi Road, Shenhe District, Shenyang, 110016, People’s Republic of China

    Yujie Wang

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Contributions

RJZ and YJW contributed to the study’s conception and design. RJZ and YJW performed the systematic literature search, selected studies for inclusion, extracted data, statistical analyses, and made figures. LLH, RJZ, and YJW interpreted data and wrote the first draft of the manuscript. All authors revised the manuscript for important intellectual content and approved the final draft.

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Correspondence to Ruijun Zhang.

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Huang, L., Wang, Y. & Zhang, R. Efficacy and safety of intra-arterial thrombolysis in patients with central retinal artery occlusion: a systematic review and meta-analysis. Graefes Arch Clin Exp Ophthalmol 261, 103–113 (2023). https://doi.org/10.1007/s00417-022-05797-1

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