Management of Central Retinal Artery Occlusion: A Scientific Statement From the American Heart Association

Abstract

Purpose: Central retinal artery occlusion (CRAO) is a form of acute ischemic stroke that causes severe visual loss and is a harbinger of further cerebrovascular and cardiovascular events. There is a paucity of scientific information on the appropriate management of CRAO, with most strategies based on observational literature and expert opinion. In this scientific statement, we critically appraise the literature on CRAO and provide a framework within which to consider acute treatment and secondary prevention. Methods: We performed a literature review of randomized controlled clinical trials, prospective and retrospective cohort studies, case-control studies, case reports, clinical guidelines, review articles, basic science articles, and editorials concerning the management of CRAO. We assembled a panel comprising experts in the fields of vascular neurology, neuro-ophthalmology, vitreo-retinal surgery, immunology, endovascular neurosurgery, and cardiology, and document sections were divided among the writing group members. Each member received an assignment to perform a literature review, synthesize the data, and offer considerations for practice. Multiple drafts were circulated among the group until consensus was achieved. Results: Acute CRAO is a medical emergency. Systems of care should evolve to prioritize early recognition and triage of CRAO to emergency medical attention. There is considerable variability in management patterns among practitioners, institutions, and subspecialty groups. The current literature suggests that treatment with intravenous tissue plasminogen activator may be effective. Patients should undergo urgent screening and treatment of vascular risk factors. There is a need for high-quality, randomized clinical trials in this field.

Hyperbaric Oxygen Therapy for Central Retinal Artery Occlusion: Patient Selection and Perspectives

“… 70 More than half of academic neurologists administer intravenous tPA to selected patients with acute CRAO based on observational data and in the lack of other efficient therapies. 71 There have been no adequate randomized clinical studies of intravenous tPA to date since earlier attempts were hampered by patient enrollment difficulties. Since the release of the meta-analysis of observational studies, intravenous tPA has been re-evaluated in four current cohorts with acute CRAO within 4.5 hours of onset.…”

“…Since the release of the meta-analysis of observational studies, intravenous tPA has been re-evaluated in four current cohorts with acute CRAO within 4.5 hours of onset. 71 A new meta-analysis that included these recent cohorts found that therapy within 4.5 hours had a considerable effect. 72 This analysis robustly repeated previous findings and served as the foundation for several ongoing clinical trials.…”

“…Three randomized trials (THEIA, REVISION, and TenCRAOS) are being done in Europe to compare intravenous thrombolysis to placebo in persons with CRAO who come within 4.5 hours of symptoms commencement. 71 The decision to utilize intravenous tPA for CRAO rests on a detailed conversation between the treating specialist and the affected patient, which includes an acknowledgement of the limitations inherent in the literature to date, according to the authors. 70 , 71 There is only one case report of concurrent use of HBO and tPA for CRAO.…”

“… 71 The decision to utilize intravenous tPA for CRAO rests on a detailed conversation between the treating specialist and the affected patient, which includes an acknowledgement of the limitations inherent in the literature to date, according to the authors. 70 , 71 There is only one case report of concurrent use of HBO and tPA for CRAO. This patient who had recently been diagnosed with CRAO was treated with IVT (rTPA) and HBOT, which resulted in a favorable outcome.…”

Akut arteria centralis retinae elzáródás.

“…A legfontosabb rizikófaktorok [9][10][11]: -azonos oldali a. carotis interna atherosclerosis, stenosis (a leggyakoribb kórok); -kardiológiai betegségek (patent foramen ovale, szívbillentyű-rendellenességek, ritmuszavar: a leggyakrabban pitvarfibrilláció); -a. carotis interna dissectio (nyaki trauma, Hornerszindróma); -gyulladásos (a leggyakrabban óriássejtes) arteritis; -hematológiai, hemosztazeológiai betegségek (veleszületett/szerzett); -septicus embolisatio; -iatrogén embolisatio (például orvosi diagnosztikus és szépészeti beavatkozások).…”