Abstract
Purpose
To investigate the efficacy and safety of intra-arterial thrombolysis (IAT) in patients with central retinal artery occlusion (CRAO).
Methods
PubMed and EMBASE were searched for potentially eligible studies that reported IAT in CRAO patients from inception to Nov 8, 2021. Standard mean difference (SMD) was pooled to compare visual acuity (VA) at baseline with final in IAT patients. The rates and odds ratios (OR) were meta-analyzed to compare VA improvement in IAT with non-IAT patients, stratified to different times from onset to procedure, different definitions of VA improvement, and three CRAO stages. Adverse effects were recorded.
Results
Fifteen studies were included, enrolling 507 CRAO patients who received IAT and 296 CRAO patients who did not. VA was significantly improved from baseline to final VA in IAT patients (SMD [LogMAR] 0.70, 95% CI [0.51, 0.90]). VA improvement rate was higher in IAT patients than that in non-IAT (56% vs 32%, OR 3.55, 95%CI [1.74, 7.24]), with greater OR in IAT within 6 h from onset to procedure (OR 4.60, 95%CI [1.24, 16.99]) than that beyond 6 h (OR 3.36, 95%CI [1.43, 7.85]). The benefit remained consistent when VA improvement was defined as ≥ 3 lines on the Snellen chart (OR 4.68, 95%CI [2.10, 10.41]) and was even greater when CRAO was incomplete. Five patients had a symptomatic intracranial hemorrhage and 21 patients had ischemic stroke or transient ischemic attack after IAT.
Conclusions
IAT treatment has certain potential in ameliorating VA in CRAO patients, which should be balanced against cerebral complications.
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Abbreviations
- CI:
-
Confidence interval
- CRAO:
-
Central retinal artery occlusion
- IAT:
-
Intra-arterial thrombolysis
- ICH:
-
Intracranial hemorrhage
- IVT:
-
Intravenous thrombolysis
- MD:
-
Mean difference
- OR:
-
Odds ratio
- SMD:
-
Standard mean difference
- VA:
-
Visual acuity
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RJZ and YJW contributed to the study’s conception and design. RJZ and YJW performed the systematic literature search, selected studies for inclusion, extracted data, statistical analyses, and made figures. LLH, RJZ, and YJW interpreted data and wrote the first draft of the manuscript. All authors revised the manuscript for important intellectual content and approved the final draft.
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Huang, L., Wang, Y. & Zhang, R. Efficacy and safety of intra-arterial thrombolysis in patients with central retinal artery occlusion: a systematic review and meta-analysis. Graefes Arch Clin Exp Ophthalmol 261, 103–113 (2023). https://doi.org/10.1007/s00417-022-05797-1
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DOI: https://doi.org/10.1007/s00417-022-05797-1