Document Detail

Combined central retinal arterial and venous obstruction: emergency ophthalmic arterial fibrinolysis.
MedLine Citation:
PMID:  11997537     Owner:  NLM     Status:  MEDLINE    
PURPOSE: To investigate the role of urokinase selectively perfused into the ophthalmic artery as an emergency treatment for combined central retinal arterial obstruction (CRAO) and central retinal venous obstruction (CRVO). MATERIALS AND METHODS: Over a 6-year period, 11 consecutive patients presented with recent combined CRAO and CRVO (< or =72 hours). Urokinase (300,000 IU) was selectively perfused via the femoral artery into the ophthalmic artery for 40 minutes. Evaluation criteria were Snellen visual acuity with best correction, funduscopic results, and retinal arteriovenous transit time assessed over a mean 3.5-year follow-up. Mean vision and retinal perfusion were tested by means of repeated-measures analysis of variance. The correlation between visual improvement and retinal perfusion improvement was evaluated by means of Spearman rank correlation. RESULTS: Substantial improvement in vision and retinal perfusion was noted in seven of the 11 patients treated. Mean vision improvement was significant (P =.009) within 24-48 hours after fibrinolysis, increased until 1 month after (P =.006), then remained stable throughout the follow-up (P >.10). Visual improvement correlated with retinal perfusion improvement during the period from before fibrinolysis to 24-48 hours after (P =.028). In all patients with improved results, retinal hemorrhages transiently increased. One patient had intravitreal hemorrhage shortly after fibrinolysis. CONCLUSION: For this uncommon clinical entity, which typically has a poor visual outcome, these results suggest that ophthalmic arterial fibrinolysis may restore retinal perfusion, which leads to rapid substantial visual improvement in many cases of combined CRAO and CRVO, without systemic complications, but it may be responsible for intravitreal hemorrhage.
Jean-Noël Vallée; Michel Paques; Armand Aymard; Pascale Massin; Pierre-Yves Santiago; Patrice Adeleine; Alain Gaudric; Jean-Jacques Merland
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Radiology     Volume:  223     ISSN:  0033-8419     ISO Abbreviation:  Radiology     Publication Date:  2002 May 
Date Detail:
Created Date:  2002-05-08     Completed Date:  2002-06-13     Revised Date:  2008-11-21    
Medline Journal Info:
Nlm Unique ID:  0401260     Medline TA:  Radiology     Country:  United States    
Other Details:
Languages:  eng     Pagination:  351-9     Citation Subset:  AIM; IM    
Copyright Information:
Copyright RSNA, 2002
Department of Neuroradiology, Hôpital Lariboisière, University of Paris, France.
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MeSH Terms
Analysis of Variance
Arterial Occlusive Diseases / complications,  diagnosis,  drug therapy*
Blood Flow Velocity
Diagnostic Tests, Routine
Infusions, Intravenous
Middle Aged
Ophthalmic Artery*
Plasminogen Activators / therapeutic use*
Retinal Vein Occlusion / complications,  diagnosis,  drug therapy*
Statistics, Nonparametric
Thrombolytic Therapy / methods*
Treatment Outcome
Urokinase-Type Plasminogen Activator / therapeutic use*
Visual Acuity
Reg. No./Substance:
EC 3.4.21.-/Plasminogen Activators; EC Plasminogen Activator

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