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Predictors of prognosis and treatment outcome in central retinal artery occlusion: local intra-arterial fibrinolysis vs. conservative treatment

  • Interventional Neuroradiology
  • Published:
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Abstract

Introduction

The study analyses patients’ risk factors to determine prognostic and predictive factors in patients with acute central retinal artery occlusion (CRAO) treated in the randomized European Assessment Group for Lysis in the Eye (EAGLE) Study with local intra-arterial fibrinolysis (LIF) or conservative standard treatment (CST). These data could improve patient selection for either method.

Methods

Post hoc statistical analysis of effects of risk factors on overall best corrected visual acuity (BCVA [logarithm of the minimum angle of resolution (logMAR)]) at baseline and month 1 (prognostic effect) and on the difference between outcome of CST and LIF (predictive effect) was conducted.

Results

Seventy two of 84 EAGLE datasets were included. Prognostic effect: Patients with coronary heart disease (CHD) presented worse BCVA at baseline (0.39 logMAR, p = 0.0097). Patients with time from occlusion to treatment <12 h showed a trend to better vision gain at month 1 (−0.23 logMAR, p = 0.086), similarly smoking (−0.24 logMAR, p = 0.077). Predictive effect: Age (<60 years favours LIF −0.54 logMAR; >70 years favours CST 0.28 logMAR; interaction p = 0.070) and CHD (favours CST 0.44 logMAR; interaction p = 0.073) might be predictors of therapeutic outcome. There were no strong effects in multivariate analysis.

Conclusion

CHD, time from occlusion to treatment and smoking influence BCVA at baseline and at month 1 (prognostic effect). Patients treated within 12 h are more likely to profit from treatment. In multivariate analysis, there is no clear trend to benefit from LIF even in patients with young age, no CHD and early treatment. Based on this preliminary report on a rather small sample size, we do not recommend LIF in CRAO patients.

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Acknowledgments

The EAGLE Study received funding from The German Research Foundation of Health (DFG), Bonn, Germany (SCHU1454/1-3) and from Boehringer Ingelheim Pharma KG. The Clinical Trials Center, University Hospital Freiburg, received funding from the Federal Ministry of Education and Research (BMBF). AP received support as awardee of the Ellen-Schmidt-Program of Hannover Medical School.

Ethical standards and patient consent

We declare that all human and animal studies have been approved by the appropriate Ethics Committee and have therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. We declare that all patients gave informed consent prior to inclusion in this study, Clinical Trial Registration-URL: http://www.clinicaltrials.gov Unique identifier: NCT00637468.

Conflict of interest

We declare that we have no conflict of interest.

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Author notes

    Authors and Affiliations

    1. University Medical Center Freiburg, University Eye Hospital, Freiburg, Germany

      Amelie Pielen & Bernd Junker

    2. Hannover Medical School, University Eye Hospital, Carl-Neuberg-Str. 1, 30625, Hannover, Germany

      Amelie Pielen & Bernd Junker

    3. University Hospital Göttingen, University Eye Hospital, Göttingen, Germany

      Stefanie Pantenburg, Nicolas Feltgen & Josep Callizo

    4. University Medical Center Freiburg, Clinical Trials Unit, Freiburg, Germany

      Claudia Schmoor

    5. University Medical Center Freiburg, Neuroradiology, Freiburg, Germany

      Martin Schumacher

    Authors
    1. Amelie Pielen
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    2. Stefanie Pantenburg
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    3. Claudia Schmoor
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    4. Martin Schumacher
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    for the EAGLE Study Group

    Corresponding author

    Correspondence to Amelie Pielen.

    Additional information

    BJ and JC contributed equally to this work.

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    Pielen, A., Pantenburg, S., Schmoor, C. et al. Predictors of prognosis and treatment outcome in central retinal artery occlusion: local intra-arterial fibrinolysis vs. conservative treatment. Neuroradiology 57, 1055–1062 (2015). https://doi.org/10.1007/s00234-015-1588-3

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    • DOI: https://doi.org/10.1007/s00234-015-1588-3

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