HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Figures Only Full Text Full Text (PDF) All Versions of this Article: 2232010423v1 223/2/351    most recent Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Vallée, J.-N. Articles by Merland, J.-J. Search for Related Content PubMed PubMed Citation Articles by Vallée, J.-N. Articles by Merland, J.-J.

Combined Central Retinal Arterial and Venous Obstruction: Emergency Ophthalmic Arterial Fibrinolysis¹

¹ From the Departments of Neuroradiology and Therapeutic Angiography (J.N.V., A.A., J.J.M.) and Ophthalmology (M.P., P.M., P.Y.S., A.G.), Hôpital Lariboisière, University of Paris, France; and Department of Biostatistics and Medical Informatics, University of Lyon, France (P.A.). Received February 7, 2001; revision requested March 26; final revision received August 23; accepted September 14. Address correspondence to J.N.V., Federation of Neuroradiology, Charcot Diagnostic and Interventional Neuroradiology Service, Groupe Hospitalo-Universitaire Pitié-Salpétrière, 43-87 boulevard de l’Hôpital, 75651 Paris Cedex 13, France (e-mail: jean-noel.vallee@psl.ap-hop-paris.fr).

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 (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.

© RSNA, 2002

Index terms: Eye, abnormalities, 1724.124, 1724.1265, 1724.752, 2245.124, 2245.492 • Eye, hemorrhage, 1724.1265 • Retina, 1724.752, 2245.1265, 2245.492 • Urokinase, 1724.1265, 2245.1265

This article has been cited by other articles:

				H Shahid, P Hossain, and W M Amoaku The management of retinal vein occlusion: is interventional ophthalmology the way forward? Br. J. Ophthalmol., May 1, 2006; 90(5): 627 - 639. [Abstract] [Full Text] [PDF]