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Intra-arterial thrombolysis for central retinal artery occlusion: two cases report.

Hwang G, Woo SJ, Jung C, Park KH, Hwang JM, Kwon OK - J. Korean Med. Sci. (2010)

Bottom Line: Central retinal artery occlusion (CRAO) causes severe visual loss in affected eye and vision does not recover in more than 90% of the patients.Of them, one recovered visual acuity to 20/25.To the best of our knowledge, this is the first Korean report of IAT for CRAO.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, Chuncheon Sacred Heart Hospital, Hallym University, Chuncheon, Korea.

ABSTRACT
Central retinal artery occlusion (CRAO) causes severe visual loss in affected eye and vision does not recover in more than 90% of the patients. It is believed that it occurs by occlusion of the central retinal artery with small emboli from atherosclerotic plaque of internal cerebral artery. Retina is a part of the brain, thus basically CRAO is corresponding to acute occlusion of intracerebral artery and retinal ischemia is to cerebral stroke. Therefore, intra-arterial thrombolysis (IAT) has been considered as a treatment method in CRAO. Recently, we treated 2 patients diagnosed as CRAO and could achieve complete recanalization on fundus fluorescein angiogram with IAT. Of them, one recovered visual acuity to 20/25. We report our 2 CRAO cases treated with IAT and discuss technical aspects for IAT and management of patient. To the best of our knowledge, this is the first Korean report of IAT for CRAO.

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Related in: MedlinePlus

Fundus photography (A) and fluorescein angiography (B). One day after intra-arterial thrombolysis in case 1. Perfusion of retinal vessels were normalized and retinal color was restored to normal orange hue. However, there still remained macular edema (A). Retinal arterial and venous filling was normalized with arterio-venous transit time was 18 sec (B).
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Figure 3: Fundus photography (A) and fluorescein angiography (B). One day after intra-arterial thrombolysis in case 1. Perfusion of retinal vessels were normalized and retinal color was restored to normal orange hue. However, there still remained macular edema (A). Retinal arterial and venous filling was normalized with arterio-venous transit time was 18 sec (B).

Mentions: During the procedure, we could not find any improvement of retinal perfusion on fundus examination and the patient had no subjective improvement of vision. After IAT, anticoagulation was not done, systemically. One hour after thrombolysis, the patient experienced marked restoration of vision and visual field. At one day after thrombolysis, his visual acuity was hand motion while he could see 20/100 using his temporal visual field. The fundus fluorescein angiography showed normalized retinal arterial filling with AV transit time of 18 sec (Fig. 3). The b wave amplitude of maximal combined response of electroretinogram was 331.7 uV in his right eye and 250.2 uV in his left eye. However, he had severe macular edema on optical coherence tomography and showed no further improvement of vision thereafter. Because there was no newly developed neurologic sign implying brain lesions, the brain imaging study was not performed, additionally.


Intra-arterial thrombolysis for central retinal artery occlusion: two cases report.

Hwang G, Woo SJ, Jung C, Park KH, Hwang JM, Kwon OK - J. Korean Med. Sci. (2010)

Fundus photography (A) and fluorescein angiography (B). One day after intra-arterial thrombolysis in case 1. Perfusion of retinal vessels were normalized and retinal color was restored to normal orange hue. However, there still remained macular edema (A). Retinal arterial and venous filling was normalized with arterio-venous transit time was 18 sec (B).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2877243&req=5

Figure 3: Fundus photography (A) and fluorescein angiography (B). One day after intra-arterial thrombolysis in case 1. Perfusion of retinal vessels were normalized and retinal color was restored to normal orange hue. However, there still remained macular edema (A). Retinal arterial and venous filling was normalized with arterio-venous transit time was 18 sec (B).
Mentions: During the procedure, we could not find any improvement of retinal perfusion on fundus examination and the patient had no subjective improvement of vision. After IAT, anticoagulation was not done, systemically. One hour after thrombolysis, the patient experienced marked restoration of vision and visual field. At one day after thrombolysis, his visual acuity was hand motion while he could see 20/100 using his temporal visual field. The fundus fluorescein angiography showed normalized retinal arterial filling with AV transit time of 18 sec (Fig. 3). The b wave amplitude of maximal combined response of electroretinogram was 331.7 uV in his right eye and 250.2 uV in his left eye. However, he had severe macular edema on optical coherence tomography and showed no further improvement of vision thereafter. Because there was no newly developed neurologic sign implying brain lesions, the brain imaging study was not performed, additionally.

Bottom Line: Central retinal artery occlusion (CRAO) causes severe visual loss in affected eye and vision does not recover in more than 90% of the patients.Of them, one recovered visual acuity to 20/25.To the best of our knowledge, this is the first Korean report of IAT for CRAO.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, Chuncheon Sacred Heart Hospital, Hallym University, Chuncheon, Korea.

ABSTRACT
Central retinal artery occlusion (CRAO) causes severe visual loss in affected eye and vision does not recover in more than 90% of the patients. It is believed that it occurs by occlusion of the central retinal artery with small emboli from atherosclerotic plaque of internal cerebral artery. Retina is a part of the brain, thus basically CRAO is corresponding to acute occlusion of intracerebral artery and retinal ischemia is to cerebral stroke. Therefore, intra-arterial thrombolysis (IAT) has been considered as a treatment method in CRAO. Recently, we treated 2 patients diagnosed as CRAO and could achieve complete recanalization on fundus fluorescein angiogram with IAT. Of them, one recovered visual acuity to 20/25. We report our 2 CRAO cases treated with IAT and discuss technical aspects for IAT and management of patient. To the best of our knowledge, this is the first Korean report of IAT for CRAO.

Show MeSH
Related in: MedlinePlus