Efficacy of Intravenous Tissue-Type Plasminogen Activator in Central Retinal Artery Occlusion
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- Celia S. Chen
- From the Department of Ophthalmology (C.S.C., T.L.) and Flinders Comprehensive Stroke Centre (A.W.L.), Flinders Medical Centre and University, Bedford Park; Department of Neurology (B.C., M.P.), Royal Melbourne Hospital, Parkville; Royal Victorian Eye and Ear Hospital (M.P.), East Melbourne; Save Sight Institute (C.F., J.G.), University of Sydney, Sydney; and the Stroke Unit (R.M.), St Vincent's Hospital, Darlinghurst, Australia.
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- Andrew W. Lee
- From the Department of Ophthalmology (C.S.C., T.L.) and Flinders Comprehensive Stroke Centre (A.W.L.), Flinders Medical Centre and University, Bedford Park; Department of Neurology (B.C., M.P.), Royal Melbourne Hospital, Parkville; Royal Victorian Eye and Ear Hospital (M.P.), East Melbourne; Save Sight Institute (C.F., J.G.), University of Sydney, Sydney; and the Stroke Unit (R.M.), St Vincent's Hospital, Darlinghurst, Australia.
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- Bruce Campbell
- From the Department of Ophthalmology (C.S.C., T.L.) and Flinders Comprehensive Stroke Centre (A.W.L.), Flinders Medical Centre and University, Bedford Park; Department of Neurology (B.C., M.P.), Royal Melbourne Hospital, Parkville; Royal Victorian Eye and Ear Hospital (M.P.), East Melbourne; Save Sight Institute (C.F., J.G.), University of Sydney, Sydney; and the Stroke Unit (R.M.), St Vincent's Hospital, Darlinghurst, Australia.
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- Tien Lee
- From the Department of Ophthalmology (C.S.C., T.L.) and Flinders Comprehensive Stroke Centre (A.W.L.), Flinders Medical Centre and University, Bedford Park; Department of Neurology (B.C., M.P.), Royal Melbourne Hospital, Parkville; Royal Victorian Eye and Ear Hospital (M.P.), East Melbourne; Save Sight Institute (C.F., J.G.), University of Sydney, Sydney; and the Stroke Unit (R.M.), St Vincent's Hospital, Darlinghurst, Australia.
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- Mark Paine
- From the Department of Ophthalmology (C.S.C., T.L.) and Flinders Comprehensive Stroke Centre (A.W.L.), Flinders Medical Centre and University, Bedford Park; Department of Neurology (B.C., M.P.), Royal Melbourne Hospital, Parkville; Royal Victorian Eye and Ear Hospital (M.P.), East Melbourne; Save Sight Institute (C.F., J.G.), University of Sydney, Sydney; and the Stroke Unit (R.M.), St Vincent's Hospital, Darlinghurst, Australia.
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- Clare Fraser
- From the Department of Ophthalmology (C.S.C., T.L.) and Flinders Comprehensive Stroke Centre (A.W.L.), Flinders Medical Centre and University, Bedford Park; Department of Neurology (B.C., M.P.), Royal Melbourne Hospital, Parkville; Royal Victorian Eye and Ear Hospital (M.P.), East Melbourne; Save Sight Institute (C.F., J.G.), University of Sydney, Sydney; and the Stroke Unit (R.M.), St Vincent's Hospital, Darlinghurst, Australia.
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- John Grigg
- From the Department of Ophthalmology (C.S.C., T.L.) and Flinders Comprehensive Stroke Centre (A.W.L.), Flinders Medical Centre and University, Bedford Park; Department of Neurology (B.C., M.P.), Royal Melbourne Hospital, Parkville; Royal Victorian Eye and Ear Hospital (M.P.), East Melbourne; Save Sight Institute (C.F., J.G.), University of Sydney, Sydney; and the Stroke Unit (R.M.), St Vincent's Hospital, Darlinghurst, Australia.
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- Romesh Markus
- From the Department of Ophthalmology (C.S.C., T.L.) and Flinders Comprehensive Stroke Centre (A.W.L.), Flinders Medical Centre and University, Bedford Park; Department of Neurology (B.C., M.P.), Royal Melbourne Hospital, Parkville; Royal Victorian Eye and Ear Hospital (M.P.), East Melbourne; Save Sight Institute (C.F., J.G.), University of Sydney, Sydney; and the Stroke Unit (R.M.), St Vincent's Hospital, Darlinghurst, Australia.
書誌事項
- タイトル別名
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- Report From a Randomized, Controlled Trial
説明
<jats:sec> <jats:title>Background and Purpose—</jats:title> <jats:p>Central retinal artery occlusion is caused by a platelet-fibrin thrombus or embolic occlusion and is a stroke of the eye. Observational studies suggest that thrombolytics may restore ocular perfusion and visual function. We hypothesized that intravenous tissue-type plasminogen activator (tPA) administered within 24 hours of symptom onset might restore ocular perfusion and visual function.</jats:p> </jats:sec> <jats:sec> <jats:title>Methods—</jats:title> <jats:p>A placebo-controlled, randomized trial of intravenous tPA versus intravenous saline was performed in patients with clinically defined central retinal artery occlusion within 24 hours of symptom onset. tPA was administered at a total dose of 0.9 mg/kg, with 10% given as a 1-minute bolus and the remainder over 1 hour. An improvement of visual acuity of 3 lines or more was considered significant.</jats:p> </jats:sec> <jats:sec> <jats:title>Results—</jats:title> <jats:p>Twenty-five percent (2 of 8) of the tPA group experienced the primary outcome at 1 week after tPA versus none of the placebo group. One patient had an intracranial hemorrhage. The visual acuity improvement of these 2 patients was not sustained at 6 months. In both patients, tPA was administered within 6 hours of symptom onset.</jats:p> </jats:sec> <jats:sec> <jats:title>Conclusions—</jats:title> <jats:p>Although essentially a negative study, it does add to the evidence base of reperfusion in central retinal artery occlusion by showing that the time window for intervention is likely to be <6 hours. Reocclusion is a potential problem and may require adjuvant anticoagulation. Future studies should concentrate on determining the efficacy of thrombolytics in the <6-hour time window.</jats:p> </jats:sec> <jats:sec> <jats:title>Clinical Trial Registration—</jats:title> <jats:p> URL: <jats:ext-link xmlns:xlink="http://www.w3.org/1999/xlink" ext-link-type="uri" xlink:href="http://www.anzctr.org.au">http://www.anzctr.org.au</jats:ext-link> . Unique identifier: 83102. </jats:p> </jats:sec>
収録刊行物
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- Stroke
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Stroke 42 (8), 2229-2234, 2011-08
Ovid Technologies (Wolters Kluwer Health)