ObjectiveTo observe alterations in center retinal thickness (CRT) in patients diagnosed with central retinal artery occlusion (CRAO) before and after undergoing superselective arterial thrombolysis (IAT) treatment. MethodsA retrospective clinical study. From August 2022 to September 2023, 12 patients (12 eyes) diagnosed with CRAO and treated with IAT at the ophthalmology department of Shenzhen Second People's Hospital. Among these patients, there were 8 males (8 eyes) and 4 females (4 eyes), all experiencing unilateral onset. The mean age was (47.00±15.06) years. The mean duration from onset to thrombolysis was (30.00±30.42) h. All eyes underwent best corrected visual acuity (BCVA) and optical coherence tomography (OCT) assessments; additionally, 6 eyes underwent Fluorescein fundus angiography (FFA). BCVA assessments were conducted using a standard logarithmic chart and transformed into logarithm of the minimum angle of resolution (logMAR) values for statistical analysis. The OCT measured CRT at various locations around the macular fovea (M), including upper (S1, S3), lower (I1, I3), nasal (N1, N3), and temporal (T1, T3) areas at 1 mm and 3 mm distances from the fovea. CRT was defined as the vertical distance between the inner retinal boundary membrane and the inner interface of the retinal pigment epithelial layer. Pre- and post-IAT examinations were performed using the same equipment and methodologies within a 24-hour interval. Changes in CRT at different macular points were compared and observed, while arterial imaging time changes were assessed in 6 eyes that underwent FFA. Paired t-tests were utilized to analyze logMAR BCVA, CRT at different locations, and arterial imaging time pre- and post-treatment. ResultsPrior to IAT treatment, the logMAR BCVA for the affected eye was 3.48±1.42, while the arterial imaging time for the 6 eyes undergoing FFA examination was (27.50±5.47) s. After 24 hours, the logMAR BCVA had improved to 2.35±1.59 for the affected eye, with 9 eyes showing varying degrees of BCVA improvement. The arterial imaging time was (24.17±7.28) s post-treatment. The differences in logMAR BCVA and arterial imaging time before and after treatment were found to be statistically significant (t=2.489, 3.262; P＜0.05). Additionally, the comparison of CRT at S3 (t=2.871), I1 (t=2.325), and T3 (t=3.446) before and after treatment yielded statistically significant differences (P＜0.05). Conversely, the comparison of CRT at S1 (t=1.879), I3 (t=1.915), N1 (t=2.001), N3 (t=1.987), T1 (t=2.180), and M (t=－0.490) showed no statistically significant differences (P＞0.05). ConclusionsIAT treatment for CRAO has been shown to be effective in achieving therapeutic effects by reducing CRT in the macular area. However, the short-term improvement in retinal edema in the macular area is limited.
Tissue plasminogen activator (t-PA), a serine protease capable of promoting fibrin degradation and thrombus dissolution, plays a pivotal role in the management of cardiovascular and cerebrovascular diseases. In recent years, its ophthalmic applications have expanded significantly. Intravitreal administration of t-PA demonstrates efficacy in inducing posterior vitreous detachment, thereby enhancing surgical success rates. Combined application with vitrectomy markedly improves outcomes in subretinal hemorrhage management. Systemic thrombolysis via intravenous or intra-arterial routes effectively alleviates central retinal artery occlusion, while suprachoroidal injection facilitates resolution of suprachoroidal hemorrhage. Notably, the synergistic effect of subretinal co-administration with anti-vascular endothelial growth factor agents enhances anti-angiogenic efficacy, offering novel therapeutic strategies for ocular neovascular disorders. In the future, it is necessary to further clarify the best indication of t-PA, improve the treatment scheme, and explore the combined application with other treatment methods to promote the innovation of ophthalmic treatment.
