J Korean Med Sci.  2010 Jun;25(6):974-979. 10.3346/jkms.2010.25.6.974.

Intra-arterial Thrombolysis for Central Retinal Artery Occlusion: Two Cases Report

• Hwang G
• Woo SJ
• Jung C
• Park KH
• Hwang JM
• Kwon OK

• KMID: 2150884
• DOI: http://doi.org/10.3346/jkms.2010.25.6.974

Abstract

Central retinal artery occlusion (CRAO) causes severe visual loss in affected eye and vision does not recover in more than 90% of the patients. It is believed that it occurs by occlusion of the central retinal artery with small emboli from atherosclerotic plaque of internal cerebral artery. Retina is a part of the brain, thus basically CRAO is corresponding to acute occlusion of intracerebral artery and retinal ischemia is to cerebral stroke. Therefore, intra-arterial thrombolysis (IAT) has been considered as a treatment method in CRAO. Recently, we treated 2 patients diagnosed as CRAO and could achieve complete recanalization on fundus fluorescein angiogram with IAT. Of them, one recovered visual acuity to 20/25. We report our 2 CRAO cases treated with IAT and discuss technical aspects for IAT and management of patient. To the best of our knowledge, this is the first Korean report of IAT for CRAO.

Keyword

Central Retinal Artery Occlusion; Thrombolysis

Figure

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  Fig. 1 Fundus photography (A) and fluorescein angiography (B) before intra-arterial thrombolysis in case 1. There was white edematous retina with typical cherry-red spot and fragmentation of retinal vessels compatible with central retinal artery occlustion (A). Retinal arterial filling was markedly delayed with arterio-venous transit time of 5 min. The choroidal perfusion was normal (B).

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  Fig. 2 Arterial phase and venous phase of left internal carotid angiogram (A) in case 1. Ophthalmic artery and chroidal blush were observed. Selective angiogram before and after intra-arterial thrombolysis (B). There was no definite occlusion in ciliary arteries and other muscular branches from ophthalmic artery. Intra-arterial thrombolysis was performed with urokinase and abxicimab.

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  Fig. 3 Fundus photography (A) and fluorescein angiography (B). One day after intra-arterial thrombolysis in case 1. Perfusion of retinal vessels were normalized and retinal color was restored to normal orange hue. However, there still remained macular edema (A). Retinal arterial and venous filling was normalized with arterio-venous transit time was 18 sec (B).

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  Fig. 4 Fundus photogrphy (A) and fluorescein angiography (B) before intra-arterial thrombolysis in case 2. There is diffuse ischemic retinal edema throughout the entire fundus (A). The visual acuity was 20/70. There is delay in arterial filling and the arteriovenous transit time is 70 sec (B).

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  Fig. 5 Common carotid angiogram in case 2 (A). There was no definite occlusion and remarkable lesion in ophthalmic artery and main trunk of intracerebral arteries. Selective angiogram of ophthalmic artery after intra-arterial thrombolysis (B). The muscular branches and ciliary arteries were well shown.

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  Fig. 6 Fluorescein angiography 1day after intra-arterial thrombolysis in case 2 (A). The retinal perfusion restored to normal and arteriovenous transit time is 12 sec. Fundus photography 2 weeks after thrombolysis (B). There is no more retinal edema suggesting previous ischemia. The vision improved to 20/25.

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