Selective thrombolysis of central retinal artery occlusion without long-term systemic heparinization

Surg Neurol. 1998 Nov;50(5):408-10. doi: 10.1016/s0090-3019(97)00338-8.

Abstract

Background: A central retinal artery occlusion is a potentially blinding retinal vascular event with no effective treatment regimen available. Recently, a few reports have described improved vision in eyes with central retinal artery occlusions after selective fibrinolytic therapy followed by long-term systemic anticoagulation. Acceptance of this treatment, however, has been hampered by a paucity of confirmatory reports and its potential for producing serious hemorrhagic complications. Our report independently confirms the beneficial effects of selective thrombolysis, even with the use of only short-term, post-procedure systemic heparinization.

Methods: A case report of selective fibrinolysis of an occluded central retinal artery using urokinase infusion into the ophthalmic artery followed with only 12 h of systemic heparinization is described.

Results: A 65-year-old man presenting with a central retinal artery occlusion of less than 4-h duration enjoyed an improvement of vision from counting-fingers acuity to 20/20 after selective fibrinolysis with urokinase and only 12 h of systemic heparinization. No hemorrhagic or thrombotic complications occurred.

Conclusions: Selective thrombolysis with urokinase followed by short-term systemic heparinization can effectively treat a central retinal artery occlusion. Whereas the authors acknowledge that a single case does not prove that short-term heparinization is better than long-term heparinization, it does show that the latter is not always required.

Publication types

  • Case Reports
  • Clinical Trial

MeSH terms

  • Aged
  • Angiography / methods
  • Fibrinolytic Agents / therapeutic use*
  • Heparin / therapeutic use*
  • Humans
  • Infusions, Intra-Arterial
  • Male
  • Ophthalmic Artery / diagnostic imaging
  • Retinal Artery Occlusion / diagnostic imaging
  • Retinal Artery Occlusion / drug therapy*
  • Thrombolytic Therapy / methods*
  • Time Factors
  • Treatment Outcome
  • Urokinase-Type Plasminogen Activator / therapeutic use

Substances

  • Fibrinolytic Agents
  • Heparin
  • Urokinase-Type Plasminogen Activator