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Randomized Controlled Trial
. 2017 Jan 8:23:114-120.
doi: 10.12659/msm.898352.

Evaluation of Ophthalmic Artery Branch Retrograde Intervention in the Treatment of Central Retinal Artery Occlusion (CRAO)

Runsheng Wang  1 , Lu Qian  2 , Yi Wang  3 , Yi Zheng  3 , Shanshuang Du  1 , Tao Lei  2 , Peilin Lv  4 , Tan Long  4 , Wenjun Wang  1
Affiliations
Randomized Controlled Trial

Evaluation of Ophthalmic Artery Branch Retrograde Intervention in the Treatment of Central Retinal Artery Occlusion (CRAO)

Runsheng Wang et al. Med Sci Monit. .

Abstract

BACKGROUND Central retinal artery occlusion (CRAO) is the occlusion of the central retinal artery resulting in retinal infarction and acute vision loss. Digital subtraction angiography (DSA)-guided superselective ophthalmic artery or selective carotid thrombolysis remains the preferred treatment method for CRAO. This study aimed to evaluate the safety and clinical efficacy of the novel ophthalmic artery branch retrograde thrombolytic intervention for CRAO. MATERIAL AND METHODS Fifty patients with monocular CRAO were enrolled, including 28 males and 22 females (mean age: 55.7±2.3 years). The patients were randomly divided into two groups for thrombolysis with urokinase (400,000 U) and papaverine (30 mg) by either ophthalmic artery branch retrograde intervention (group A, n=26) or superselective ophthalmic artery/selective carotid intervention (group B, n=24). There was no significant difference in age (P=0.58), gender ratio (P=0.49), and time to onset (P=1.00) between the two groups. The adverse reactions and clinical efficacy were evaluated by postoperative DSA, fundus fluorescein angiography (FFA), and visual acuity tests. RESULTS No serious complications, abnormal eye movement, or vitreous hemorrhage occurred in either group. DSA showed that group A had an effective rate (92.30%) comparable to that of group B (100%, χ²=2.08, P=0.25). FFA suggested that both groups had similar treatment efficacy (χ²=3.09, P=0.21). Visual acuity tests also confirmed a similar efficacy of the two intervention approaches (χ²=0.25, P=0.88). CONCLUSIONS The developed novel ophthalmic artery branch retrograde intervention is highly effective and safe for CRAO, and may be a superior method compared with the conventional approach.

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Conflict of interest statement

Conflict of interests The author declare no conflict of interests.

Figures

Figure 1
Figure 1
The supratrochlear or supraorbital artery was exposed by blunt dissection.
Figure 2
Figure 2
A microcatheter with a guidewire was pierced through the blood vessel wall.
Figure 3
Figure 3
A DSA image showing the ophthalmic artery and a clear ring around the eye, which confirms the proper insertion of the catheter.
Figure 4
Figure 4
A DSA image showing the thickened ophthalmic artery and clearer ring around the eye.
Figure 5
Figure 5
FFA images in group A before the surgery. (A) An FFA image showing posterior pole opacity, edema, and a cherry-red macular spot. (B) An FFA image at 48 s showing the retrograde filling of the occluded vessel. (C) An FFA image at 320 s showing disc staining and arterial segmental filling.
Figure 6
Figure 6
FFA images in group A after the surgery. (A) An FFA image showing improved retinal edema. (B) An FFA image at 13 s showing full retinal artery filling. (C) An FFA image at 17 s showing full filling of the retinal artery and vein.
Figure 7
Figure 7
FFA images in group B before the surgery. (A) An FFA image showing posterior pole opacity, edema, and a cherry-red macular spot. (B) An FFA image at 18 s showing the retrograde filling of the occluded vessel. (C) An FFA image at 22 s showing the retrograde filling of the occluded vessel.
Figure 8
Figure 8
FFA images in group B after the surgery. (A) An FFA image showing improved retinal edema. (B) An FFA image at 13 s showing retinal artery filling. (C) An FFA image at 17 s showing peripheral retinal arterial filling.
See this image and copyright information in PMC

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