Skip to main content

Advertisement

SpringerLink
Log in

Acute phase treatment in central retinal artery occlusion: thrombolysis, hyperbaric oxygen therapy or both?

  • Published:
Journal of Thrombosis and Thrombolysis Aims and scope Submit manuscript

Abstract

Central retinal artery occlusion (CRAO) is a neuro-ophthalmological emergency. There is a finite time window for acute interventions such as revascularization (e.g. intravenous thrombolysis—IVT) and retinal oxygenation (e.g. hyperbaric oxygen therapy—HBOT) therapies. Case 1: A 35-year-old female presented with CRAO in the right eye (OD) confirmed by fluorescein angiography (FA) and optical coherence tomography (OCT). She underwent 4 sessions of HBOT (100% O2 at 2.4 atmosphere absolute for 90 min). Afterwards, visual defect on the nasal field was kept but visual acuity (VA) improved from counting fingers to 1.0. Case 2: A 65-year-old male presented with CRAO in his left eye (OS) with 1.5 h of evolution. Orbital sonography and OCT confirmed the presence of an embolus and he underwent IVT with rTPA (0.9 mg/kg). VA improved from light perception to 0.1. Case 3: A 21-year-old male presented acute visual loss in his OD with 2.5 h of evolution. OCT and retinography identified CRAO. He was submitted to IVT (rTPA-0.9 mg/kg) followed by 12 sessions of HBOT. VA improved from hand motion to 1.0. Our case series depicts the approaches and possible outcomes in acute management of an infrequent, but highly morbid, cerebroretinovascular disorder. Future clinical trials are warranted to tackle current difficulties in CRAO treatment.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

References

  1. Leavitt JA, Larson TA, Hodge DO, Gullerud RE (2011) The incidence of central retinal artery occlusion in Olmsted County, Minnesota. Am J Ophthalmol 152(5):820–823.e822. https://doi.org/10.1016/j.ajo.2011.05.005

    Article  PubMed  PubMed Central  Google Scholar 

  2. Hayreh SS, Zimmerman MB (2005) Central retinal artery occlusion: visual outcome. Am J Ophthalmol 140(3):376–391. https://doi.org/10.1016/j.ajo.2005.03.038

    Article  PubMed  Google Scholar 

  3. Hayreh SS (2011) Acute retinal arterial occlusive disorders. Progr Retinal Eye Res 30(5):359–394. https://doi.org/10.1016/j.preteyeres.2011.05.001

    Article  Google Scholar 

  4. Hayreh SS (2014) Ocular vascular occlusive disorders: natural history of visual outcome. Progr Retinal Eye Res 41:1–25. https://doi.org/10.1016/j.preteyeres.2014.04.001

    Article  Google Scholar 

  5. Hayreh SS, Zimmerman MB, Kimura A, Sanon A (2004) Central retinal artery occlusion. Retinal Surviv Time Exp Eye Res 78(3):723–736

    CAS  Google Scholar 

  6. Schrag M, Youn T, Schindler J, Kirshner H, Greer D (2015) Intravenous fibrinolytic therapy in central retinal artery occlusion: a patient-level meta-analysis. JAMA Neurol 72(10):1148–1154. https://doi.org/10.1001/jamaneurol.2015.1578

    Article  PubMed  Google Scholar 

  7. Varma DD, Cugati S, Lee AW, Chen CS (2013) A review of central retinal artery occlusion: clinical presentation and management. Eye (Lond) 27(6):688–697. https://doi.org/10.1038/eye.2013.25

    Article  CAS  Google Scholar 

  8. Cope A, Eggert JV, O'Brien E (2011) Retinal artery occlusion: visual outcome after treatment with hyperbaric oxygen. Diving Hyperb Med 41(3):135–138

    PubMed  Google Scholar 

  9. Menzel-Severing J, Siekmann U, Weinberger A, Roessler G, Walter P, Mazinani B (2012) Early hyperbaric oxygen treatment for nonarteritic central retinal artery obstruction. Am J Ophthalmol 153(3):454–459.e452. https://doi.org/10.1016/j.ajo.2011.08.009

    Article  CAS  PubMed  Google Scholar 

  10. Youn TS, Lavin P, Patrylo M, Schindler J, Kirshner H, Greer DM, Schrag M (2018) Current treatment of central retinal artery occlusion: a national survey. J Neurol 265(2):330–335. https://doi.org/10.1007/s00415-017-8702-x

    Article  PubMed  Google Scholar 

  11. Wu X, Chen S, Li S, Zhang J, Luan D, Zhao S, Chu Z, Xu Y (2018) Oxygen therapy in patients with retinal artery occlusion: a meta-analysis. PLoS ONE 13(8):e0202154. https://doi.org/10.1371/journal.pone.0202154

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Murphy-Lavoie H, Butler F, Hagan C (2012) Central retinal artery occlusion treated with oxygen: a literature review and treatment algorithm. Undersea Hyperb Med 39(5):943–953

    CAS  PubMed  Google Scholar 

  13. Hattenbach LO, Kuhli-Hattenbach C, Scharrer I, Baatz H (2008) Intravenous thrombolysis with low-dose recombinant tissue plasminogen activator in central retinal artery occlusion. Am J Ophthalmol 146(5):700–706. https://doi.org/10.1016/j.ajo.2008.06.016

    Article  CAS  PubMed  Google Scholar 

  14. Kattah JC, Wang DZ, Reddy C (2002) Intravenous recombinant tissue-type plasminogen activator thrombolysis in treatment of central retinal artery occlusion. Arch Ophthalmol (Chicago Il: 1960) 120(9):1234–1236

    Article  Google Scholar 

  15. Weinberger AW, Siekmann UP, Wolf S, Rossaint R, Kirchhof B, Schrage NF (2002) Treatment of acute central retinal artery occlusion (CRAO) by hyperbaric oxygenation therapy (HBO)–pilot study with 21 patients. Klinische Monatsblatter fur Augenheilkunde 219(10):728–734. https://doi.org/10.1055/s-2002-35687

    Article  PubMed  Google Scholar 

  16. Kuppers-Tiedt L, Manaenko A, Michalski D, Guenther A, Hobohm C, Wagner A, Zhang JH, Schneider D (2011) Combined systemic thrombolysis with alteplase and early hyperbaric oxygen therapy in experimental embolic stroke in rats: relationship to functional outcome and reduction of structural damage. Acta Neurochir Suppl 111:167–172. https://doi.org/10.1007/978-3-7091-0693-8_28

    Article  PubMed  Google Scholar 

  17. Michalski D, Pelz J, Weise C, Kacza J, Boltze J, Grosche J, Kamprad M, Schneider D, Hobohm C, Hartig W (2011) Early outcome and blood-brain barrier integrity after co-administered thrombolysis and hyperbaric oxygenation in experimental stroke. Exp Transl Stroke Med 3(1):5. https://doi.org/10.1186/2040-7378-3-5

    Article  PubMed  PubMed Central  Google Scholar 

  18. Nedelmann M, Graef M, Weinand F, Wassill K-H, Kaps M, Lorenz B, Tanislav CJS (2015) Retrobulbar spot sign predicts thrombolytic treatment effects and etiology in central retinal artery occlusion. Stroke 46(8):2322–2324

    Article  Google Scholar 

Download references

Funding

Not applicable.

Author information

Authors and Affiliations

  1. Department of Neurology, Centro Hospitalar Universitário de São João, EPE, Porto, Portugal

    Daniel Ferreira, Carolina Soares, Rui Araújo & Pedro Castro

  2. Department of Clinic Neurosciences and Mental Health, Medical Faculty of Porto University, Porto, Portugal

    Daniel Ferreira, Carolina Soares, Rui Araújo & Pedro Castro

  3. Department of Ophthalmology, Centro Hospitalar Universitário de São João, EPE, Porto, Portugal

    João Tavares-Ferreira

  4. Hyperbaric Medicine Unit, Unidade Local de Saúde de Matosinhos, Porto, Portugal

    Tiago Fernandes

  5. Stroke Unit and Neurology Department, Centro Hospitalar Universitário de São João, EPE, Porto, Portugal

    Pedro Castro

Authors
  1. Daniel Ferreira
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Carolina Soares
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. João Tavares-Ferreira
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Tiago Fernandes
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Rui Araújo
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Pedro Castro
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

DF contributed to acquisition, analysis and interpretation of the data, drafting of the manuscript, concept and design. CS contributed to analysis and interpretation of the data and provided significant input for early and final drafts of the manuscript. JT-F contributed to the acquisition, analysis and interpretation of the data, study supervision and critical revision of manuscript. TF contributed to the acquisition, analysis and interpretation of the data, study supervision and critical revision of manuscript. RA contributed to the analysis and interpretation of the data, study supervision and provided significant input for early and final drafts of the manuscript. PC contributed to the acquisition, analysis and interpretation of the data, study supervision and critical revision of manuscript.

Corresponding author

Correspondence to Daniel Ferreira.

Ethics declarations

Conflicts of interest

The authors declare that they have no conflict of interest.

Informed consent

Written informed consents for publication of their clinical details and/or clinical images were obtained from the patients. A copy of the consent forms is available for review by the Editor of this journal.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ferreira, D., Soares, C., Tavares-Ferreira, J. et al. Acute phase treatment in central retinal artery occlusion: thrombolysis, hyperbaric oxygen therapy or both?. J Thromb Thrombolysis 50, 984–988 (2020). https://doi.org/10.1007/s11239-020-02072-0

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11239-020-02072-0

Keywords

Search

Navigation