S Beatty1, K G Au Eong. 1. Academic Department of Ophthalmology, Manchester Royal Eye Hospital. stephen@stiofanbetagh.demon.co.uk
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.
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.
Authors: M Arnold; U Koerner; L Remonda; K Nedeltchev; H P Mattle; G Schroth; M Sturzenegger; J Weber; F Koerner Journal: J Neurol Neurosurg Psychiatry Date: 2005-02 Impact factor: 10.154
Authors: N Feltgen; A Neubauer; B Jurklies; C Schmoor; D Schmidt; J Wanke; H Maier-Lenz; M Schumacher Journal: Graefes Arch Clin Exp Ophthalmol Date: 2005-12-22 Impact factor: 3.117