Efficacy of Intravenous Tissue-Type Plasminogen Activator in Central Retinal Artery Occlusion

DOI Web Site 2 Citations
  • 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.
  • 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.
  • 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.
  • 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.
  • 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.
  • 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.
  • 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.
  • 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.

Bibliographic Information

Other Title
  • Report From a Randomized, Controlled Trial

Description

<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>

Journal

  • Stroke

    Stroke 42 (8), 2229-2234, 2011-08

    Ovid Technologies (Wolters Kluwer Health)

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