Is thrombolytic treatment warranted for central retinal artery occlusion?
Reviewed by Claire Howard

Central retinal artery occlusion (CRAO) is a subtype of acute ischaemic stroke which results in severe visual loss. Acute CRAO is equivalent to a brain acute ischaemic stroke (AIS), as the obstruction of the central retinal artery (CRA) causes end-organ ischaemia followed by cell death of the retina. Although thrombolysis has proven benefit for ischaemic stroke, there are no clear guidelines on this treatment for CRAO. The authors aimed to retrospectively review their own academic multi-site stroke centre experience with intravenous (IVT) and intra-arterial thrombolysis (IAT) in CRAO between 1997 and 2022. Demographic, clinical characteristics, thrombolysis timeline, concurrent therapies, complications, and three-month follow-up visual acuity (VA) were collected. In the thrombolytic cohort follow-up, VA was compared with an age, gender and baseline VA-matched cohort of CRAO patients that received conservative therapies. Thrombolytic therapy was administered to 3.55% (n=20) of CRAO admissions. Improvement by at least two Snellen lines was achieved by 42%. The authors suggest their study shows limited utilisation of thrombolysis in patients with CRAO. However, research using larger sample sizes and a prospective design is required to guide future hyperacute CRAO management.

Thrombolytic therapy for central retinal artery occlusion in an academic multi-site stroke centre.
Alhayek N, Sobczak JM, Vanood A, et al.
NEURO-OPHTHALMOLOGY
2024;48(2):111–21.