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  • IAT Improves Vision in Patients With CRAO

    By Lynda Seminara
    Selected by Prem S. Subramanian, MD, PhD
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    Journal Highlights

    Graefe’s Archive for Clinical and Experimental Ophthalmology
    Published online Aug. 10, 2022

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    Intra-arterial thrombolysis (IAT) is a treatment option for central retinal artery occlusion (CRAO), but it has been linked to adverse events such as cerebral complications. Previous meta-analyses yielded inconsistent findings and were limited by relatively small sizes as well as differences in defi­nitions of VA improvement among the analyzed studies. To better clarify the efficacy and safety of IAT for CRAO, Huang et al. performed a larger sys­tematic review and meta-analysis. They found that VA improved significantly following IAT, but they cautioned that the treatment could have serious con­sequences that must be weighed against its advantages.

    For this work, the investigators searched PubMed and Embase for potentially relevant studies published through early November 2021. For those that met the inclusion criteria, standard mean differences (SMDs) were pooled to determine baseline and final VA of patients who received IAT for CRAO. “Baseline VA” was defined as VA at time of admission, and “final VA” denoted VA at the end of follow-up. Improvement rates and odds ratios (ORs) were analyzed to compare VA outcomes between patients who under­went IAT and those who did not. Other variables of interest included time from symptom onset to IAT and the definition of VA improvement. Adverse effects were documented to assess safety.

    In 15 studies that qualified for the meta-analysis, 507 patients with CRAO received IAT, and 296 were treated conservatively. The VA improvement rate was higher in the IAT group (56% vs. 32%; OR, 3.55) and was highest if IAT was performed within six hours of symptom onset (OR, 4.60 vs. 3.36 for later procedures). VA improvement of at least 3 Snellen lines was maintained (OR, 4.68) and was better in cases of incomplete occlusion. The serious adverse events ascribed to IAT were symptomatic intracranial hemorrhage (five patients) and ischemic stroke or transient ischemic (21 patients). Hemi­paresis occurred in one patient treated conservatively.

    These findings suggest that IAT en­hances VA in patients with CRAO and is most successful if performed shortly after symptom onset, but the risks warrant consideration, the authors said.

    The original article can be found here.