Acute central retinal artery occlusion treated with intravenous recombinant tissue plasminogen activator

Journal of Stroke and Cerebrovascular Diseases : the Official Journal of National Stroke Association
Richard J NowakJoseph L Schindler

Abstract

Central retinal artery occlusion (CRAO) causes ischemic stroke of the eye. We report a case of CRAO that was successfully treated with intravenous recombinant tissue plasminogen activator (rt-PA) and review the current literature. A 64-year-old right-handed man presented to the emergency department with acute left eye amaurosis. An ophthalmologic assessment revealed a left afferent pupillary defect, minimal visual acuity, macular edema with a cherry red spot, and multiple emboli in the inferotemporal arcade of the left eye. A neurologic examination was otherwise nonfocal; neuroimaging was normal. Acute CRAO was diagnosed, and rt-PA was administered intravenously 185 minutes after symptom onset. A repeat examination 4.5 hours after treatment found improved vision, reduced macular edema, and no emboli. An ophthalmologic evaluation 10 days later found a visual acuity of 20/200 in the left eye and bilateral arterial sclerosis without evidence of retinal emboli or macular edema. This case illustrates that intravenous rt-PA may be an effective therapeutic option for CRAO in select patients. Given the current literature and the recommended established safety window for thrombolytics in acute ischemic cerebral stroke, it is reasonable ...Continue Reading

References

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Citations

Jun 25, 2014·Journal of Stroke and Cerebrovascular Diseases : the Official Journal of National Stroke Association·Max NedelmannManfred Kaps
May 3, 2018·Asia-Pacific Journal of Ophthalmology·Rahul A SharmaValerie Biousse
Jan 17, 2021·European Journal of Neurology : the Official Journal of the European Federation of Neurological Societies·Carolin HoyerKristina Szabo

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