Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2018 Feb 21:9:76.
doi: 10.3389/fneur.2018.00076. eCollection 2018.

Intra-Arterial Thrombolysis for Acute Central Retinal Artery Occlusion: A Systematic Review and Meta-Analysis

Paul S Page  1 , Nicolas K Khattar  1 , Andrew C White  2 , Alexander C Cambon  3 , Guy N Brock  3 , Shesh N Rai  3 , Robert F James  1
Affiliations

Intra-Arterial Thrombolysis for Acute Central Retinal Artery Occlusion: A Systematic Review and Meta-Analysis

Paul S Page et al. Front Neurol. .

Abstract

Background and purpose: Acute central retinal artery occlusion (CRAO) is a serious ophthalmologic emergency that may result in monocular blindness. To date, studies evaluating intra-arterial thrombolysis (IAT) have not shown a definitive clinical benefit. We have conducted a systematic review with a meta-analysis to effectively evaluate this treatment option.

Methods: A systematic literature search was focused on studies containing five or more patients undergoing IAT that included a control group treated with standard therapy. Pooled meta-analysis was performed.

Results: Five retrospective controlled studies and one randomized clinical trial were identified satisfying all inclusion criteria resulting in the analysis of 236 patients treated with IAT and 255 patients treated with ST. A pooled fixed effects analysis resulted in an estimated odds ratio of 2.52, 95% CI (1.69, 3.77) (P < 0.0001) favoring IAT.

Conclusion: IAT is a promising therapeutic option for CRAO with great potential. Further randomized trials are needed to establish a significant benefit and ensure the safety of the intervention.

Keywords: intra-arterial infusions; meta analysis; retinal artery occlusion; revascularization; thrombolytic therapy.

PubMed Disclaimer

Figures

Figure 1
Figure 1
PRISMA flow diagram demonstrating method of systematic review.
Figure 2
Figure 2
Forest plot evaluating five retrospective controlled studies.
Figure 3
Figure 3
Forest plot evaluating five retrospective controlled studies and a randomized controlled trial. The addition of the randomized trial, which individually does not support IAT therapy, decreased the pooled odds ratio but it was still significantly in favor of intra-arterial therapy over standard therapy controls. There was an increase in heterogeneity, but this remained non-significant (P = 0.10) supporting the use of this method.
Figure 4
Figure 4
Funnel plot testing for publication bias. Formal test of funnel plot asymmetry with P = 0.47 showign a lack of publication bias.
See this image and copyright information in PMC

References

    1. Hayreh SS, Zimmerman MB. Central retinal artery occlusion: visual outcome. Am J Ophthalmol (2005) 140(3):376–91.10.1016/j.ajo.2005.03.038 - DOI - PubMed
    1. Atebara NH, Brown GC, Cater J. Efficacy of anterior chamber paracentesis and Carbogen in treating acute nonarteritic central retinal artery occlusion. Ophthalmology (1995) 102(12):2029–34; discussion 34–5.10.1016/S0161-6420(95)30758-0 - DOI - PubMed
    1. Mueller AJ, Neubauer AS, Schaller U, Kampik A, European Assessment Group for Lysis in the Eye . Evaluation of minimally invasive therapies and rationale for a prospective randomized trial to evaluate selective intra-arterial lysis for clinically complete central retinal artery occlusion. Arch Ophthalmol (2003) 121(10):1377–81.10.1001/archopht.121.10.1377 - DOI - PubMed
    1. Rudkin AK, Lee AW, Aldrich E, Miller NR, Chen CS. Clinical characteristics and outcome of current standard management of central retinal artery occlusion. Clin Exp Ophthalmol (2010) 38(5):496–501.10.1111/j.1442-9071.2010.02280.x - DOI - PubMed
    1. Fiess A, Cal O, Kehrein S, Halstenberg S, Frisch I, Steinhorst UH. Anterior chamber paracentesis after central retinal artery occlusion: a tenable therapy? BMC Ophthalmol (2014) 14:28.10.1186/1471-2415-14-28 - DOI - PMC - PubMed

LinkOut - more resources