Intra-Arterial Tissue Plasminogen Activator for Central Retinal Artery Occlusion

Figures & data

Table 1 Patients with CRAO Treated with Intra-Arterial tPA

Age	Gender	Eye	Ocular Paracentesis	Baseline BCVA	Follow-Up BCVA	Time to tPA (Hours)	tPA Dose (mg)	rAPD	Retinal Blush (Pre/Post)		Improved Retinal Blush
65–70	Female	OD	No	NLP	CF	12	22	Yes	Yes	Yes	No
70–75	Male	OD	Yes	LP	CF	5.5	22	Yes	Yes	Yes	No
45–50	Female	OS	No	LP	20/50	6	20	Yes	No	Yes	Yes
55–60	Female	OS	Yes	LP	20/800	9	22	NA	Yes	Yes	Yes
25–30	Female	OS	Yes	HM	HM	10	22	Yes	Yes	Yes	No
75–80	Female	OD	No	HM	HM	12	3	NA	Yes	Yes	Yes
85–90	Female	OD	No	NLP	20/80	11	20	None	No	Yes	Yes
65–70	Female	OD	No	NLP	NLP	6	22	Yes	Yes	Yes	No
70–75	Female	OD	Yes	LP	LP	8	20	Yes	Yes	Yes	Yes
75–80	Male	OD	Yes	HM	CF	8	3	Yes	Yes	Yes	No
55–60	Female	OD	No	CF	20/70	6	6	Yes	No	No	No
60–65	Male	OD	Yes	CF	20/30	7	17	NA	Yes	Yes	Yes
45–50	Female	OS	No	20/80	20/30	10	20	NA	Yes	No	Yes
25–30	Female	OS	No	20/200	CF	12	22	None	Yes	Yes	No
55–60	Male	OD	No	20/100	20/25	10	12	None	Yes	Yes	Yes

Notes: 1) Ages are listed as a range for de-identification. 2) If the patient had already been pharmacologically dilated or there was no pupillary exam listed, the status of a relative afferent pupillary defect (rAPD) has been listed as “not available” (NA). When there was no rAPD present or the pupillary exam was non-reactive, the status has been listed as “none.”

Abbreviations: CRAO, central retinal artery occlusion; tPA, recombinant tissue plasminogen activator; BCVA, best-corrected visual acuity (Snellen); rAPD, relative afferent pupillary defect; NA, not available.

Figure 1 A histogram demonstrating the number of lines of improvement in Snellen acuity by the frequency of occurrence, for patients treated with intra-arterial tPA for CRAO. Of the eight (53%) eyes that improved by more than three (right of the dotted line), six (75%) improved by five lines or more. Only five (33%) eyes showed no improvement or worsening, while two (13%) improved although by less than three lines.

Figure 2 Box plots representing best-corrected visual acuity before and after intervention with intra-arterial tPA for CRAO. In A and B (left), results are from all eyes (n=15) that received intervention. In C and D (right), results are from the subset of eyes (n=8) with improvement of 3 or more lines of Snellen visual acuity improvement, demonstrating the magnitude of visual improvement in cases of successful treatment. Statistical testing was done using logMAR values. ***statistical significance, p<0.05.

Figure 3 Linear regression analysis of visual acuity at 3-weeks post intervention (y-axis) as a function of visual acuity at initial presentation (x-axis) of eyes treated with intra-arterial tPA for CRAO. Results demonstrate a moderate to high association (r=0.506) with borderline statistical significance (p=0.054).

Figure 4 Left internal carotid artery cranial diffusion subtraction angiography images before and after tPA thrombolysis for CRAO. Lateral view shows minimal but present retinal blush (black arrows) before tPA injection (A). After tPA injection, improvement of the retinal blush (black arrows) is observed (B).