Intra-Arterial Tissue Plasminogen Activator for Central Retinal Artery Occlusion
Ethan K Sobol,1,2 Yu Sakai,3 Danielle Wheelwright,3 Carl S Wilkins,1,2 Amanda Norchi,1 Michael G Fara,4 Christopher Kellner,3 James Chelnis,1 J Mocco,3 Richard B Rosen,1,2 Reade A De Leacy,3 Gareth MC Lema1,2 1Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, New York, NY, 10029,...
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Dove Medical Press
2021
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oai:doaj.org-article:45d940185dcb4e41b4535cf9257d49dd2021-12-02T14:12:25ZIntra-Arterial Tissue Plasminogen Activator for Central Retinal Artery Occlusion1177-5483https://doaj.org/article/45d940185dcb4e41b4535cf9257d49dd2021-02-01T00:00:00Zhttps://www.dovepress.com/intra-arterial-tissue-plasminogen-activator-for-central-retinal-artery-peer-reviewed-article-OPTHhttps://doaj.org/toc/1177-5483Ethan K Sobol,1,2 Yu Sakai,3 Danielle Wheelwright,3 Carl S Wilkins,1,2 Amanda Norchi,1 Michael G Fara,4 Christopher Kellner,3 James Chelnis,1 J Mocco,3 Richard B Rosen,1,2 Reade A De Leacy,3 Gareth MC Lema1,2 1Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA; 2Department of Ophthalmology, New York Eye and Ear Infirmary of Mount Sinai, New York, NY, 10003, USA; 3Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA; 4Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USACorrespondence: Gareth MC LemaDepartment of Ophthalmology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY, 10029, USATel +1 212-241-0939Fax +1 212-824-2325Email gareth.lema@mssm.eduPurpose: To investigate the benefit of early intra-arterial tissue plasminogen activator (IAT) for treatment of central retinal artery occlusion (CRAO).Patients and Methods: Fifteen eyes of 15 patients presenting with acute CRAO were included in this retrospective consecutive interventional case series. Patients were excluded if treatment with IAT was not initiated within 12 hours. The diagnosis was confirmed by an ophthalmologist. IAT was performed via a transfemoral arterial approach. Tissue plasminogen activator (tPA) was infused into the ophthalmic artery in aliquots up to 3mg to a maximum of 22mg. Paracentesis was done at the ophthalmologist’s discretion. The primary outcome measure was visual acuity after three weeks. Adverse events were recorded during treatment and follow-up visits.Results: After treatment with IAT, there was a statistically significant improvement in visual acuity, with a mean change of − 0.76 (SD 0.91; range − 2.4 to 0.85) logMAR (p=0.006). Vision improved by 3 or more lines in 53%, and of these, the mean Snellen visual acuity improvement was > 6 lines. Notably, 4 patients (27%) improved from CF or worse to 20/80 or better. The mean dose of tPA used was 17mg and the mean time to treatment was 8.83 hours (range: 5.5 to 12 hours). There were no statistically significant differences based on time to treatment, dose of tPA, or use of a paracentesis. No major adverse events were recorded.Conclusion: IAT was safe and showed significant visual improvement in this small uncontrolled study. Larger studies and efforts to decrease time to treatment should be initiated to optimize outcomes.Keywords: CRAO, tPA, intervention, treatment, ophthalmic arterySobol EKSakai YWheelwright DWilkins CSNorchi AFara MGKellner CChelnis JMocco JRosen RBDe Leacy RALema GMCDove Medical Pressarticlecraotpainterventiontreatmentophthalmic arteryOphthalmologyRE1-994ENClinical Ophthalmology, Vol Volume 15, Pp 601-608 (2021) |
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crao tpa intervention treatment ophthalmic artery Ophthalmology RE1-994 |
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crao tpa intervention treatment ophthalmic artery Ophthalmology RE1-994 Sobol EK Sakai Y Wheelwright D Wilkins CS Norchi A Fara MG Kellner C Chelnis J Mocco J Rosen RB De Leacy RA Lema GMC Intra-Arterial Tissue Plasminogen Activator for Central Retinal Artery Occlusion |
| description |
Ethan K Sobol,1,2 Yu Sakai,3 Danielle Wheelwright,3 Carl S Wilkins,1,2 Amanda Norchi,1 Michael G Fara,4 Christopher Kellner,3 James Chelnis,1 J Mocco,3 Richard B Rosen,1,2 Reade A De Leacy,3 Gareth MC Lema1,2 1Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA; 2Department of Ophthalmology, New York Eye and Ear Infirmary of Mount Sinai, New York, NY, 10003, USA; 3Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA; 4Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USACorrespondence: Gareth MC LemaDepartment of Ophthalmology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY, 10029, USATel +1 212-241-0939Fax +1 212-824-2325Email gareth.lema@mssm.eduPurpose: To investigate the benefit of early intra-arterial tissue plasminogen activator (IAT) for treatment of central retinal artery occlusion (CRAO).Patients and Methods: Fifteen eyes of 15 patients presenting with acute CRAO were included in this retrospective consecutive interventional case series. Patients were excluded if treatment with IAT was not initiated within 12 hours. The diagnosis was confirmed by an ophthalmologist. IAT was performed via a transfemoral arterial approach. Tissue plasminogen activator (tPA) was infused into the ophthalmic artery in aliquots up to 3mg to a maximum of 22mg. Paracentesis was done at the ophthalmologist’s discretion. The primary outcome measure was visual acuity after three weeks. Adverse events were recorded during treatment and follow-up visits.Results: After treatment with IAT, there was a statistically significant improvement in visual acuity, with a mean change of − 0.76 (SD 0.91; range − 2.4 to 0.85) logMAR (p=0.006). Vision improved by 3 or more lines in 53%, and of these, the mean Snellen visual acuity improvement was > 6 lines. Notably, 4 patients (27%) improved from CF or worse to 20/80 or better. The mean dose of tPA used was 17mg and the mean time to treatment was 8.83 hours (range: 5.5 to 12 hours). There were no statistically significant differences based on time to treatment, dose of tPA, or use of a paracentesis. No major adverse events were recorded.Conclusion: IAT was safe and showed significant visual improvement in this small uncontrolled study. Larger studies and efforts to decrease time to treatment should be initiated to optimize outcomes.Keywords: CRAO, tPA, intervention, treatment, ophthalmic artery |
| format |
article |
| author |
Sobol EK Sakai Y Wheelwright D Wilkins CS Norchi A Fara MG Kellner C Chelnis J Mocco J Rosen RB De Leacy RA Lema GMC |
| author_facet |
Sobol EK Sakai Y Wheelwright D Wilkins CS Norchi A Fara MG Kellner C Chelnis J Mocco J Rosen RB De Leacy RA Lema GMC |
| author_sort |
Sobol EK |
| title |
Intra-Arterial Tissue Plasminogen Activator for Central Retinal Artery Occlusion |
| title_short |
Intra-Arterial Tissue Plasminogen Activator for Central Retinal Artery Occlusion |
| title_full |
Intra-Arterial Tissue Plasminogen Activator for Central Retinal Artery Occlusion |
| title_fullStr |
Intra-Arterial Tissue Plasminogen Activator for Central Retinal Artery Occlusion |
| title_full_unstemmed |
Intra-Arterial Tissue Plasminogen Activator for Central Retinal Artery Occlusion |
| title_sort |
intra-arterial tissue plasminogen activator for central retinal artery occlusion |
| publisher |
Dove Medical Press |
| publishDate |
2021 |
| url |
https://doaj.org/article/45d940185dcb4e41b4535cf9257d49dd |
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