Br J Ophthalmol 2000;84:1387-1391
( December )
Superselective ophthalmic artery fibrinolytic therapy for the
treatment of central retinal vein occlusion
M Paques, J N Vallée, D Herbreteau, A Aymart, P Y Santiago, F Campinchi-Tardy, D Payen, J J Merlan, A Gaudric, P Massin
Departments of
Ophthalmology, Neuroradiology and Anesthesiology, Hôpital
Lariboisière, Université Paris 7, Paris, France
Correspondence to: Dr Michel Paques, Department of Ophthalmology, Hôpital
Lariboisière, Assistance Publique-Hôpitaux de Paris, Université
Paris 7, 2 rue Ambroise Paré, 75475 Paris Cedex 10, France
michel.paques{at}lrb.ap-hop-paris.fr
Accepted for publication 16 June 2000
AIM
To study the
effect of superselective ophthalmic artery fibrinolysis as a treatment
for central retinal vein occlusion (CRVO).
METHODSRetrospective,
university based single centre study. The charts of 26 eyes of 26 patients treated were reviewed. Among the 26 patients, there were nine
cases of combined artery and vein occlusion, three cases of combined
cilioretinal artery and CRVO, and 14 cases of classic CRVO. Complete
preoperative and postoperative ophthalmological examination and
fluorescein angiography were performed in all cases. The therapeutic
procedure comprised the infusion of urokinase through a microcatheter
into the ostium of the ophthalmic artery, via a femoral artery
approach. The main outcome measure was the improvement in visual acuity
48 hours after the procedure.
RESULTSSix eyes of
six patients exhibited significant improvement in visual acuity
immediately after the fibrinolysis procedure. Among them, four had a
initial funduscopic appearance suggestive of combined occlusion of the
central retinal artery (CRAO) and vein. For these patients, the visual
benefit was maintained in the long term. Intravitreal haemorrhage
occurred in two patients. There were no extraocular complications
linked to the procedure.
CONCLUSIONSSelective ophthalmic
artery infusion of urokinase was followed by improvement in VA in six
out of 26 cases of CRVO. Eyes with combined CRAO and CRVO with recent
visual loss appeared to be the most responsive. This treatment did not
prevent the occurrence of ischaemia in the failure cases. The efficacy
of in situ fibrinolysis for treatment of CRVO needs to be further
evaluated in a controlled study.
© 2000 by British Journal of Ophthalmology
