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(Radiology. 2000;216:47-53.)
© RSNA, 2000

Vascular and Interventional Radiology

Superselective Ophthalmic Arterial Fibrinolysis with Urokinase for Recent Severe Central Retinal Venous Occlusion: Initial Experience1

Jean-Noël Vallée, MD, Pascale Massin, MD, Armand Aymard, MD, Michel Paques, MD, Denis Herbreteau, MD, Pierre-Yves Santiago, MD, Marie-Reine Losser, MD, PhD, Alain Gaudric, MD and Jean-Jacques Merland, MD

1 From the Departments of Neuroradiology and Therapeutic Angiography (J.N.V., A.A., D.H., J.J.M.), Ophthalmology (P.M., M.P., P.Y.S., A.G.), and Anesthesiology and Critical Care Medicine (M.R.L.), Hôpital Lariboisière, Paris, France. Received May 26, 1999; revision requested July 19; revision received November 2; accepted November 12. Address correspondence to J.N.V., Charcot Diagnostic and Interventional Neuroradiology Service, Groupe Hôpitalo-Universitaire Pitié-Salpétrière, 47-83 boulevard de l'Hôpital, 75651 Paris cedex 13, France.

PURPOSE: To investigate the effects of local ophthalmic arterial fibrinolysis on central retinal venous occlusion (CRVO).

MATERIALS AND METHODS: Thirteen patients had recent severe nonischemic CRVO for which no alternative therapy was available. A flow-guide microcatheter was introduced coaxially via the femoral artery into the ophthalmic arterial ostium, and urokinase was perfused for 40 minutes. Vision, funduscopic findings, and retinal perfusion were assessed during 1 year of follow-up.

RESULTS: Five of the 13 patients treated experienced visual improvement (P = .05) and retinal perfusion within 24–48 hours. Vision returned to normal within 24–48 hours in three patients, within 1 week in one patient, and within 1 month in one patient. These five patients exhibited progressive lesion regression within 2–4 weeks at funduscopy. Their clinical course prior to treatment resembled that of combined central retinal arterial occlusion (CRAO) and CRVO, which typically has a poor visual outcome. One patient relapsed 1 month after fibrinolysis. Of the remaining eight patients, one had normal vision at 12 months, and seven had no improvement. No technical complications were observed.

CONCLUSION: Although there was no control group, the short period between fibrinolysis and substantial visual improvement, combined with marked retinal perfusion improvement, suggests that fibrinolysis is beneficial for CRVO, especially for recent CRAO and CRVO.

Index terms: Eye, abnormalities, 1724.124, 1724.1265, 1724.752, 2245.124, 2245.89 • Retina, 17.75, 2245.1265, 2245.129, 2245.89 • Urokinase, 1724.1265, 2245.1265




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