In central retinal arterial occlusion systemic fibrinolytic therapy can involve a variety of serious complications. The local application of a fibrinolytic agent close to the embolus by means of a femoral catheter should reduce the rate of complications. We therefore present the results of a preliminary study of nine consecutive patients treated with rt-PA via transcutaneous femoral catheter.
Patients: From October 1993 to January 1994, nine patients ranging in age from 50 to 83 years who had central retinal occlusion were treated with rt-PA. The latency from the onset of the symptoms to the beginning of the therapy was 10-37 h. A catheter was placed via the femoral artery, the tip being located either at the common carotid artery or at the internal carotid artery or at the internal carotid artery. A continuous infusion containing 10 micrograms (ACTILYSE (rt-PA) was given over 2 h. Thereafter, each patient received 7000 IU heparin sulfate 4 times daily for 3 days and 1200 micrograms pentoxifylline i.v. daily for 10 days. On discharge, permanent therapy with salicylic acid (100 micrograms) was prescribed. The patients have been followed up for up to 18 months so far.
Results: In five of eight patients an improvement of central visual acuity was observed. It changed from perception of hand movement only to 12/20 in three patients. In two of these patients visual acuity had continued to improve after 6-9 months, to 16/20 and 20/20. In one patient visual acuity fell to 6/20 because of progression of ischemic ophthalmopathy. In our patients visual acuity could still be improved even 27 h after arterial occlusion.
Conclusion: A low incidence of complications and the good effect on thrombolysis support the local rt-PA therapy. Good interdisciplinary cooperation is required. Patients must be referred for this therapy as early as possible.