Effectiveness of intravenous thrombolytic therapy for central retinal artery occlusion with poor effect after arterial thrombolytic therapy_Chinese Journal of Ocular Fundus Diseases

Authors：

 Wang Runsheng , Lyu Peilin , Lei Tao , Wang Yi , Zheng Yi , Du Shanshuang

Department of Ophthalmology [Wang Runsheng, Lyu Peilin (now working at the Department of Ophthalmology, The First Hospital of Xi’an), Du Shanshuang], Department of Neurology (Lei Tao), Invasive Technology Department (Wang Yi, Zheng Yi), The Fourth Hospital of Xi’an, Xi’an 710004, China;

Corresponding?author：

Wang Runsheng, Email: wangrun-sheng0602@sohu.com

Keywords：

Retinal artery occlusion/drug therapy; Thrombolytic therapy; Urinary plasminogen activator/therapeutic use

DOI：

10.3760/cma.j.issn.1005-1015.2018.03.006

Video：

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Objective To observe the clinical effect of intravenous thrombolytic therapy for central retinal artery occlusion (CRAO) with poor effect after the treatment of arterial thrombolytic therapy. Methods Twenty-four CRAO patients (24 eyes) with poor effect after the treatment of arterial thrombolytic therapy were enrolled in this study. There were 11 males and 13 females. The age was ranged from 35 to 80 years, with the mean age of (56.7±15.6) years. There were 11 right eyes and 13 left eyes. The visual acuity was tested by standard visual acuity chart. The arm-retinal circulation time (A-Rct) and the filling time of retinal artery and its branches (FT) were detected by fluorescein fundus angiography (FFA). The visual acuity was ranged from light sensation to 0.5, with the average of 0.04±0.012. The A-Rct was ranged from 18.0 s to 35.0 s, with the mean of (29.7±5.8) s. The FT was ranged from 4.0 s to 16.0 s, with the mean of (12.9±2.3) s. All patients were treated with urokinase intravenous thrombolytic therapy. The dosage of urokinase was 3000 U/kg, 2 times/d, adding 250 ml of 0.9% sodium chloride intravenous drip, 2 times between 8 - 10 h, and continuous treatment of FFA after 5 days. Comparative analysis was performed on the visual acuity of the patients before and after treatment, and the changes of A-Rct and FT. Results After intravenous thrombolytic therapy, the A-Rct was ranged from 16.0 s to 34.0 s, with the mean of (22.4±5.5) s. Among 24 eyes, the A-Rct was 27.0 - 34.0 s in 4 eyes (16.67%), 18.0 - 26.0 s in 11 eyes (45.83%); 16.0 - 17.0 s in 9 eyes (37.50%). The FT was ranged from 2.4 s to 16.0 s, with the mean of (7.4±2.6) s. Compared with before intravenous thrombolytic therapy, the A-Rct was shortened by 7.3 s and the FT was shortened by 5.5 s with the significant differences (χ²=24.6, 24.9; P＜0.01). After intravenous thrombolytic therapy, the visual acuity was ranged from light sensation to 0.6, with the average of 0.08±0.011. There were 1 eye with vision of light perception (4.17%), 8 eyes with hand movement/20 cm (33.33%), 11 eyes with 0.02 - 0.05 (45.83%), 2 eyes with 0.1 - 0.2 (8.33%), 1 eye with 0.5 (4.17%) and 1 eye with 0.6 (4.17%). The visual acuity was improved in 19 eyes (79.17%). The difference of visual acuity before and after intravenous thrombolytic therapy was significant (χ²=7.99, P＜0.05). There was no local and systemic adverse effects during and after treatment. Conclusion Intravenous thrombolytic therapy for CRAO with poor effect after the treatment of arterial thrombolytic therapy can further improve the circulation of retinal artery and visual acuity.

Citation： Wang Runsheng, Lyu Peilin, Lei Tao, Wang Yi, Zheng Yi, Du Shanshuang. Effectiveness of intravenous thrombolytic therapy for central retinal artery occlusion with poor effect after arterial thrombolytic therapy. Chinese Journal of Ocular Fundus Diseases, 2018, 34(3): 233-236. doi: 10.3760/cma.j.issn.1005-1015.2018.03.006 Copy

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2.	Mercier J, Kastler A, Jean B, et al. Interest of local intra-arterial fibrinolysis in acute central retinal artery occlusion: clinical experience in 16 patients[J]. J Neuroradiol, 2015, 42(4): 229-235. DOI: 10.1016/j.neurad.2014.02.007.
3.	田錦林, 杜亞輝, 羅軍, 等. 視網膜中央動脈阻塞: 超選擇性眼動脈溶栓與保守治療的效果比較[J].中國介入影像與治療學, 2010, 7(4): 367-369.Tian JL, Du YH, Luo J, et al.Comparison of superselective ophthalmic artery fi brinolysis and conservative methods in treatment of central retinal artery occlusion[J]. Chin J Interv Imaging Ther, 2010, 7 (4): 367-369.
4.	李逸豐, 魏文斌. 視網膜動脈阻塞的綜合治療[J].中華實驗眼科雜志, 2017, 35(1): 93-96. DOI: 10.3760/cma.j.issn.2095-0160.2017.01.020.Li YF, Wei WB. Comprehensive therapy for retinal artery occlusion[J]. Chin J Exp Ophthalmol, 2017, 35(1): 93-96. DOI: 10.3760/cma.j.issn.2095-0160.2017.01.020.
5.	Wang R, Qian L, Wang Y, et al. Evaluation of ophthalmic artery branch retrograde intervention in the treatment of central retinal artery occlusion (CRAO)[J]. Med Sci Monit, 2017, 23: 114-120 DOI: 10.12659/MSM.898352.
6.	王潤生, 錢路, 王毅, 等.眼動脈分支逆行介入溶栓治療視網膜中央動脈阻塞療效觀察[J].中華眼底病雜志, 2016, 32(4): 377-381. DOI: 10.3760/cma.j.issn.1005-1015.2016.04.008.Wang RS, Qian L, Wang Y, et al. Ophthalmic artery branch retrograde interventional therapy for central retinal artery occlusion[J] Chin J Ocul Fundus Dis, 2016, 32(4): 377-381. DOI: 10.3760/cma.j.issn.1005-1015.2016.04.008.
7.	王潤生, 雷濤, 王毅, 等. 超選擇性眼動脈及選擇性頸內動脈溶栓治療視網膜中央動脈阻塞的療效觀察[J].中華眼底病雜志, 2014, 30(5): 450-453.DOI: 10.3760/cma.j.issn.1005-1015.2014.05.005.Wang RS, Lei T, Wang Y, et al. Super-selective ophthalmic artery or selective carotid artery thrombolytic therapy for central retinal artery occlusion [J]. Chin J Ocul Fundus Dis, 2014, 30(5): 450-453. DOI: 10.3760/cma.j.issn.1005-1015.2014.05.005.
8.	王潤生, 呂沛霖, 張婭萍, 等. 以尿激酶靜脈溶栓為主治療視網膜中央動脈阻塞115例臨床療效觀察[J]. 中華眼底病雜志, 2012, 28(5): 466-471. DOI: 10.3760/cma.i-issn.1005-101 5.2012.05.009.Wang RS, Lyu PL, Zhang YP, et al. Intravenous thrombolysis with urokinase for central retinal artery occlusion in 115 patients[J].Chin J Ocul Fundus Dis, 2012, 28(5): 466-471. DOI: 10.3760/cma.i-issn.1005-101 5.2012.05.009.
9.	吳航, 劉大川, 吉訓明, 等. 選擇性眼動脈溶栓治療CRAO前后眼底熒光素血管造影的改變[J].眼科新進展, 2010, 30(9): 884-886.Wu H, Liu DC, Ji XM, et al.Changes of fundus fluorescein angiography in patients with central retinal artery occlusion before and after treatment of selective ophthalmic artery thrombolysis[J].Rec Adv Ohtthalmol. 2010, 30 (9): 884-886.
10.	吳航, 劉大川, 吉訓明, 等, 視網膜中央動脈阻塞選擇性溶栓與常規治療前后眼底熒光血管造影對比[J]. 中國實用眼科雜志, 2010, 30(7): 738-741. DOI: 10.3760/cma.j.issn.1006-4443.2010.07.015.Wu H, Liu DC, Ji XM, et al. Comparison of selective intra-arterial fibrinolysis with conventional treatment in patient with acute central retinal artery occlusion by fundus fluorescein angiography[J].Chin J Pract Ophthalmol, 2010, 30(7): 738-741.DOI: 10.3760/cma.j.issn.1006-4443.2010.07.015.
11.	Ahn SJ, Park KH, Ryoo NK, et al. No-reflow phenomenon in central retinal artery occlusion: incidence, risk factors, and clinical implications[J/OL]. PLoS One, 2015, 10(11): 0142852[2015-11-23].http://dx.plos.org/10.1371/journal.pone.0142852. DOI: 10.1371/journal.pone.0142852.
12.	王潤生, 呂沛霖, 王賓, 等. 視網膜中央動脈阻塞患者視網膜循環時間與中心視力損害的關系[J].中華眼底病雜志, 2007, 23(3): 177-179.Wang RS, Lyu PL, Wang B, et al. Relationship between retinal circulation time and visual loss in patients with central retinal artery occlusion[J].Chin J Ocal Fundus Dis, 2007, 23(3): 177-179.

1. Cugati S, Varma DD, Chen CS, et al. Treatment options for central retinal artery occlusion[J]. Curr Treat Options Neurol, 2013, 15(1): 63-77. DOI: 10.1007/s11940-012-0202-9.
2. Mercier J, Kastler A, Jean B, et al. Interest of local intra-arterial fibrinolysis in acute central retinal artery occlusion: clinical experience in 16 patients[J]. J Neuroradiol, 2015, 42(4): 229-235. DOI: 10.1016/j.neurad.2014.02.007.
3. 田錦林, 杜亞輝, 羅軍, 等. 視網膜中央動脈阻塞: 超選擇性眼動脈溶栓與保守治療的效果比較[J].中國介入影像與治療學, 2010, 7(4): 367-369.Tian JL, Du YH, Luo J, et al.Comparison of superselective ophthalmic artery fi brinolysis and conservative methods in treatment of central retinal artery occlusion[J]. Chin J Interv Imaging Ther, 2010, 7 (4): 367-369.
4. 李逸豐, 魏文斌. 視網膜動脈阻塞的綜合治療[J].中華實驗眼科雜志, 2017, 35(1): 93-96. DOI: 10.3760/cma.j.issn.2095-0160.2017.01.020.Li YF, Wei WB. Comprehensive therapy for retinal artery occlusion[J]. Chin J Exp Ophthalmol, 2017, 35(1): 93-96. DOI: 10.3760/cma.j.issn.2095-0160.2017.01.020.
5. Wang R, Qian L, Wang Y, et al. Evaluation of ophthalmic artery branch retrograde intervention in the treatment of central retinal artery occlusion (CRAO)[J]. Med Sci Monit, 2017, 23: 114-120 DOI: 10.12659/MSM.898352.
6. 王潤生, 錢路, 王毅, 等.眼動脈分支逆行介入溶栓治療視網膜中央動脈阻塞療效觀察[J].中華眼底病雜志, 2016, 32(4): 377-381. DOI: 10.3760/cma.j.issn.1005-1015.2016.04.008.Wang RS, Qian L, Wang Y, et al. Ophthalmic artery branch retrograde interventional therapy for central retinal artery occlusion[J] Chin J Ocul Fundus Dis, 2016, 32(4): 377-381. DOI: 10.3760/cma.j.issn.1005-1015.2016.04.008.
7. 王潤生, 雷濤, 王毅, 等. 超選擇性眼動脈及選擇性頸內動脈溶栓治療視網膜中央動脈阻塞的療效觀察[J].中華眼底病雜志, 2014, 30(5): 450-453.DOI: 10.3760/cma.j.issn.1005-1015.2014.05.005.Wang RS, Lei T, Wang Y, et al. Super-selective ophthalmic artery or selective carotid artery thrombolytic therapy for central retinal artery occlusion [J]. Chin J Ocul Fundus Dis, 2014, 30(5): 450-453. DOI: 10.3760/cma.j.issn.1005-1015.2014.05.005.
8. 王潤生, 呂沛霖, 張婭萍, 等. 以尿激酶靜脈溶栓為主治療視網膜中央動脈阻塞115例臨床療效觀察[J]. 中華眼底病雜志, 2012, 28(5): 466-471. DOI: 10.3760/cma.i-issn.1005-101 5.2012.05.009.Wang RS, Lyu PL, Zhang YP, et al. Intravenous thrombolysis with urokinase for central retinal artery occlusion in 115 patients[J].Chin J Ocul Fundus Dis, 2012, 28(5): 466-471. DOI: 10.3760/cma.i-issn.1005-101 5.2012.05.009.
9. 吳航, 劉大川, 吉訓明, 等. 選擇性眼動脈溶栓治療CRAO前后眼底熒光素血管造影的改變[J].眼科新進展, 2010, 30(9): 884-886.Wu H, Liu DC, Ji XM, et al.Changes of fundus fluorescein angiography in patients with central retinal artery occlusion before and after treatment of selective ophthalmic artery thrombolysis[J].Rec Adv Ohtthalmol. 2010, 30 (9): 884-886.
10. 吳航, 劉大川, 吉訓明, 等, 視網膜中央動脈阻塞選擇性溶栓與常規治療前后眼底熒光血管造影對比[J]. 中國實用眼科雜志, 2010, 30(7): 738-741. DOI: 10.3760/cma.j.issn.1006-4443.2010.07.015.Wu H, Liu DC, Ji XM, et al. Comparison of selective intra-arterial fibrinolysis with conventional treatment in patient with acute central retinal artery occlusion by fundus fluorescein angiography[J].Chin J Pract Ophthalmol, 2010, 30(7): 738-741.DOI: 10.3760/cma.j.issn.1006-4443.2010.07.015.
11. Ahn SJ, Park KH, Ryoo NK, et al. No-reflow phenomenon in central retinal artery occlusion: incidence, risk factors, and clinical implications[J/OL]. PLoS One, 2015, 10(11): 0142852[2015-11-23].http://dx.plos.org/10.1371/journal.pone.0142852. DOI: 10.1371/journal.pone.0142852.
12. 王潤生, 呂沛霖, 王賓, 等. 視網膜中央動脈阻塞患者視網膜循環時間與中心視力損害的關系[J].中華眼底病雜志, 2007, 23(3): 177-179.Wang RS, Lyu PL, Wang B, et al. Relationship between retinal circulation time and visual loss in patients with central retinal artery occlusion[J].Chin J Ocal Fundus Dis, 2007, 23(3): 177-179.

Chinese Journal of Ocular Fundus Diseases

Effectiveness of intravenous thrombolytic therapy for central retinal artery occlusion with poor effect after arterial thrombolytic therapy

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