Efficacy and safety of intra-arterial thrombolysis in patients with central retinal artery occlusion: a systematic review and meta-analysis

Graefes Arch Clin Exp Ophthalmol. 2023 Jan;261(1):103-113. doi: 10.1007/s00417-022-05797-1. Epub 2022 Aug 10.


Purpose: To investigate the efficacy and safety of intra-arterial thrombolysis (IAT) in patients with central retinal artery occlusion (CRAO).

Methods: PubMed and EMBASE were searched for potentially eligible studies that reported IAT in CRAO patients from inception to Nov 8, 2021. Standard mean difference (SMD) was pooled to compare visual acuity (VA) at baseline with final in IAT patients. The rates and odds ratios (OR) were meta-analyzed to compare VA improvement in IAT with non-IAT patients, stratified to different times from onset to procedure, different definitions of VA improvement, and three CRAO stages. Adverse effects were recorded.

Results: Fifteen studies were included, enrolling 507 CRAO patients who received IAT and 296 CRAO patients who did not. VA was significantly improved from baseline to final VA in IAT patients (SMD [LogMAR] 0.70, 95% CI [0.51, 0.90]). VA improvement rate was higher in IAT patients than that in non-IAT (56% vs 32%, OR 3.55, 95%CI [1.74, 7.24]), with greater OR in IAT within 6 h from onset to procedure (OR 4.60, 95%CI [1.24, 16.99]) than that beyond 6 h (OR 3.36, 95%CI [1.43, 7.85]). The benefit remained consistent when VA improvement was defined as ≥ 3 lines on the Snellen chart (OR 4.68, 95%CI [2.10, 10.41]) and was even greater when CRAO was incomplete. Five patients had a symptomatic intracranial hemorrhage and 21 patients had ischemic stroke or transient ischemic attack after IAT.

Conclusions: IAT treatment has certain potential in ameliorating VA in CRAO patients, which should be balanced against cerebral complications.

Keywords: Adverse effects; Central retinal artery occlusion; Intra-arterial thrombolysis; Meta-analysis; Visual acuity.

Publication types

  • Meta-Analysis
  • Systematic Review

MeSH terms

  • Fibrinolytic Agents / therapeutic use
  • Humans
  • Infusions, Intra-Arterial
  • Retinal Artery Occlusion* / diagnosis
  • Retinal Artery Occlusion* / drug therapy
  • Thrombolytic Therapy* / adverse effects
  • Thrombolytic Therapy* / methods
  • Visual Acuity


  • Fibrinolytic Agents