ObjectiveTo compare the clinical effects of urokinase thrombolytic therapy for optic artery occlusion (OAO) and retinal artery occlusion (RAO) caused by facial microinjection with hyaluronic acid and spontaneous RAO.MethodsFrom January 2014 to February 2018, 22 eyes of 22 patients with OAO and RAO caused by facial microinjection of hyaluronic acid who received treatment in Xi'an Fourth Hospital were enrolled in this retrospective study (hyaluronic acid group). Twenty-two eyes of 22 patients with spontaneous RAO were selected as the control group. The BCVA examination was performed using the international standard visual acuity chart, which was converted into logMAR visual acuity. FFA was used to measure arm-retinal circulation time (A-Rct) and filling time of retinal artery and its branches (FT). Meanwhile, MRI examination was performed. There were significant differences in age and FT between the two groups (t=14.840, 3.263; P=0.000, 0.003). The differecens of logMAR visual acuity, onset time and A-Rct were not statistically significant between the two groups (t=0.461, 0.107, 1.101; P=0.647, 0.915, 0.277). All patients underwent urokinase thrombolysis after exclusion of thrombolytic therapy. Among the patients in the hyaluronic acid group and control group, there were 6 patients of retrograde ophthalmic thrombolysis via the superior pulchlear artery, 6 patients of retrograde ophthalmic thrombolysis via the internal carotid artery, and 10 patients of intravenous thrombolysis. FFA was reviewed 24 h after treatment, and A-Rct and FT were recorded. Visual acuity was reviewed 30 days after treatment. The occurrence of adverse reactions during and after treatment were observed. The changes of logMAR visual acuity, A-Rct and FT before and after treatment were compared between the two groups using t-test.ResultsAt 24 h after treatment, the A-Rct and FT of the hyaluronic acid group were 21.05±3.42 s and 5.05±2.52 s, which were significantly shorter than before treatment (t=4.569, 2.730; P=0.000, 0.000); the A-Rct and FT in the control group were 19.55±4.14 s and 2.55±0.91 s, which were significantly shorter than before treatment (t=4.114, 7.601; P=0.000, 0.000). There was no significant difference in A-Rct between the two groups at 24 h after treatment (t=1.311, P=0.197). The FT difference was statistically significant between the two groups at 24 h after treatment (t=4.382, P=0.000). There was no significant difference in the shortening time of A-Rct and FT between the two groups (t=0.330, 0.510; P=0.743, 0.613). At 30 days after treatment, the logMAR visual acuity in the hyaluronic acid group and the control group were 0.62±0.32 and 0.43±0.17, which were significantly higher than those before treatment (t=2.289, 5.169; P=0.029, 0.000). The difference of logMAR visual acuity between the two groups after treatment was statistically significant (t=2.872, P=0.008). The difference in logMAR visual acuity before and after treatment between the two groups was statistically significant (t=2.239, P=0.025). No ocular or systemic adverse reactions occurred during or after treatment in all patients. ConclusionsUrokinase thrombolytic therapy for OAO and RAO caused by facial microinjection with hyaluronic acid and spontaneous RAO is safe and effective, with shortening A-Rct, FT and improving visual acuity. However, the improvement of visual acuity after treatment of OAO and RAO caused by facial microinjection with hyaluronic acid is worse than that of spontaneous RAO.
Purpose To analyze the relationship of retinal artery occlusion(RAO) with the white blood cell(WBC) count and inflammatory diseases away from the eyes. Methods Ninety-fours patients with retinal artery occlusion were studied retrospectively.The patients were divided into 2 groups,one of which with inflammatory diseases,the other without.An age and sex matched control group was made. Results Fifty four(58%) cases had inflammatory diseases of various causes at the same time,among which only 14(26%) cases directly involved the eyes.WBC count was significantly higher after the occurrence of RAO(Plt;0.05),comparing with that of the control group. Conclusion Inflammatory diseases away from the eyes may be oneof the factors causing RAO.The increased WBC count may be an inflammatory reaction to RAO. (Chin J Ocul Fundus Dis,1998,14:159-161)
ObjectiveTo analyze the causal relationship between SARS-CoV-2 infection and retinal vascular obstruction by mendelian randomization (MR). MethodsA two-sample MR analysis utilizing summary statistics from genome-wide association studies (GWAS) in European populations was conducted. The GWAS data for SARS-CoV-2 infection comprised cases of common infection (2 597 856), hospitalized infection (2 095 324), and severe infection (1 086 211). Data on retinal vascular obstruction were obtained from the FinnGen database, which included 203 269 cases of retinal artery obstruction and 182 945 cases of retinal vein obstruction (RVO). Inverse variance weighting (IVW), random effects models, weighted median (WM), MR-Egger regression, simple models, and weighted models were used to analyze the bidirectional causal relationship between different SARS-CoV-2 infection phenotypes and retinal obstruction. The Q statistic was used to assess heterogeneity among single nucleotide polymorphisms (SNP), while MR-Presso was utilized to detect SNP outliers, and MR-Egger intercept tests were performed to evaluate horizontal pleiotropy. ResultsThe MR analysis, using IVW, random effects models, MR-Egger, WM, and weighted models, indicated no significant association between common SARS-CoV-2 infection, hospitalized infection, severe infection, and retinal vascular obstruction (P＞0.05). Additionally, retinal vascular obstruction did not show a significant association with the various SARS-CoV-2 infection phenotypes (P＞0.05). In the simple model, a significant association was found between severe SARS-CoV-2 infection and RVO (P＜0.05), as well as between RVO and common SARS-CoV-2 infection (P＜0.05). No heterogeneity was observed in the IVW and MR-Egger analyses (P＞0.05). The MR-Egger test provided no evidence of horizontal pleiotropy (P＞0.05), and MR-Presso detected no outlier SNP. ConclusionThe findings of this study do not support a causal relationship between SARS-CoV-2 infection and the occurrence of retinal vascular obstruction.
ObjectiveTo observe the cilioretinal artery and its relationship with central visual loss in central retinal artery occlusion(CRAO) patients. MethodsA total of 140 CRAO patients (140 eyes) were enrolled in this study. The patients included 83 males and 57 females. The age was ranged from 42 to 75 years old, with an average of (55.70±22.20) years. All the patients were affected unilaterally, including 79 right eyes and 61 left eyes. The disease duration was from 1 to 10 days, with a mean of (4.7±3.9) hours. Central vision and fluorescence fundus angiography were measured for all patients. The central visual loss was divided into 3 types: mild (≥0.1), moderate (finger counting to 0.08) and severe (no light perception to hand movement). The number, length and location of cilioretinal artery were observed. The correlation between cilioretinal artery and central visual loss was analyzed. ResultsThere were 41 eyes (29.3%) with cilioretinal artery, which including 13 eyes (31.7%) with ≥3 cilioretinal arteries, 23 eyes (56.1%) with 2 cilioretinal arteries, 5 eyes (12.2%) with 1 cilioretinal arteries. The cilioretinal artery was within 1 disk diameter (DD) in length and not reached the macular area in 37 eyes (90.2%), was more than 1DD in length and reached the macular foveal area in 4 eyes (9.8%). The cilioretinal artery located in the temporal side of optic disk in 29 eyes (70.7%), and in other quadrant in 12 eyes (29.3%). The distribution of central visual loss degree as follow: mild in 15 eyes (10.7%), moderate in 50 eyes (35.7%), severe in 75 eyes (53.6%). The difference of central visual loss in the eyes with or without cilioretinal arteries was not significant (χ2=0.16, P>0.05). ConclusionsCilioretinal artery exists in 29.3% CRAO eyes. There was no close correlation between cilioretinal artery and central visual loss.
ObjectiveTo investigate the therapeutic effects of thrombolysis infusion via microcatheter on the treatment of central retinal artery occlusion(CRAO). MethodsUrokinase (UK) was directly infused via ophthalmic artery (OA) by microcatheter (6 patients) or via intravenous (7 patients) to dissolve the thrombus. The patency of the artery was evaluated by fundus fluorescein angiography (FFA), and the effect of fibrinolytic activity on the systemic changes was observed by blood biochemical examination simultaneously. ResultsIn 6 patients in the microcatheter group, 5 had completely and 1 had partly reopened OA on the morrow of UK infusion with the patency rate of 83.33%, while in 7 patients in vein group, 3 completely reopened, 2 partly reopened and 2 obstructed OA were found with the patency rate of 42.86%. The difference between the two groups was significant. No obvious change of index of blood coagulation system was found in catheter group, which had great disparity compared with the vein group.ConclusionUrokinase infusion via microcatheter in CRAO has better therapeutic impact and smaller effect on systemic action. (Chin J Ocul Fundus Dis, 2005,21:16-19)
Objective To investigate the therapeutic effects of throm bolytic drug infusion via carotid artery on experimental central retinal artery occlusion (CRAO), and observe the changes of fibrinolytic activity in the system ic circulation. Methods To dissolve the thrombi in 15 cats (30 eyes) with CRAO established by laser irradiating a branch of central retinal a rtery after intravenous injection of photochemical drugs, urokinase (UK) was dir ectly infused via carotid artery in 5 cats (10 eyes) in group A or intravenously injected in 5 cats (10 eyes) in group B, and isotonic saline solution was intra venously injected in 5 cats (10 eyes) in group C respectively. The patency of the artery was evaluated by fundus fluorescein angiography. Moreover, the changes of fibrinolitic activity in the blood were observed by blood biochemical examination. Results Four hours after UK infusion, the complete repatency proportion was 80% (5 cats 8 eyes) in group A, and 50% (4 cats 5 eyes) in group B. There was significant difference between the two groups. Besides, after the infusion, the indexes of coagulation, fibrinolysis, and anti-fibrinolysis in group A were better than those in group B and C (Plt;0.01). Conclusion In the treatment of experimental CRAO, thrombolytic drug infusion via carotid artery is better and more effective than via intravenous injection, which may provide a new method of thrombolytic drug delivery and animal models. (Chin J Ocul Fundus Dis，2004，20：186-188)
Objective To explore the short-term efficacy and safety of intra-arterial thrombolysis (IAT) in the treatment of retinal artery occlusion (RAO) with the assistance of the rescue green channel in the eye stroke center. Methods A prospective, interventional, single-center study. Thirty-eight eyes from 38 RAO patients who received IAT treatment in Guangdong Provincial People’s Hospital were enrolled. All the patients were rescued via the green channel in our eye stroke center. Data from comprehensive ocular examinations including best-corrected visual acuity (BCVA) and optical coherence tomography angiography (OCTA) were collected. BCVA was measured with Snellen chart and converted to the logarithmic minimum angle of resolution (logMAR) unit for statistical analysis. RTVue XR OCTA was used to measure vascular densities (VD) of the superficial capillary plexus (SCP), deep capillary plexus (DCP) and radial peripapillary capillary (RPC), and central retinal thickness (CRT). All RAO eyes attempted IAT treatment and 34 eyes were successful. Four eyes failed to complete IAT because of the occlusion of internal or common carotid arteries on the same side with the RAO eyes. Ocular examinations in post-operative 1-3 days were performed with the same devices and methods as those before surgery. Parameters measured before and after surgery include BCVA, VD of SCP, DCP, RPC, and CRT. Data of the green channel collected include the time intervals from onset of RAO to first presentation in local hospitals, and from onset of RAO to our eye stroke center. Comparisons of VD and CRT between the RAO eyes and contralateral healthy eyes were performed with independent samples Mann-Whitney U test; comparisons of VD and CRT in RAO eyes before and after IAT surgery were performed with paired samples Wilcoxon Rank Sum test. Results Among the 34 RAO patients who had successful IAT surgery, 18 (52.9%, 18/34) were males and 16 (47.1%, 16/34) were females; the mean age was (51.0±12.9) years old. There were 30 and 4 eyes diagnosed as central RAO and branch RAO respectively. The logMAR BCVA before and after IAT surgery was 2.52±0.61 and 2.18±0.85 respectively, and the difference was statistically significant (Z=－3.453, P=0.002). Before surgery, VD of SCP, DCP and RPC were significantly decreased and CRT was significantly increased in the affected eye compared with the contralateral healthy eyes, with the statistical significance (P＜0.001). Compared with those before surgery, the VD of SCP and DCP were significantly improved after surgery (Z=－2.523, －2.427; P=0.010, 0.014), while there was no difference in VD of RPC and CRT (Z=－1.448, －1.454; P=0.150, 0.159). The time interval between onset of RAO and first visit to the hospital was (6.56±6.73) hours; the time interval between onset of RAO and the arrival at our hospital was (24.11±19.90) hours. No cerebral stroke was observed in the early post-operative period and no cerebrocardiovascular events were observed later. he time interval between onset of RAO and the arrival at our hospital was (24.11±19.90) hours. No cerebral stroke was observed in the early post-operative period and no cerebrocardiovascular events were observed later. Conclusions The short-term efficacy and safety of IAT in the treatment of RAO were satisfactory. The rescue time window might be prolonged.
Embolus occlusion in the retinal artery is the most common cause of central retinal artery occlusion (CRAO), while hypertension is the most common risk factor of CRAO, and ipsilateral carotid artery stenosis is the most significant risk factor in CRAO. Current clinical treatments include conservative treatments such as dilation of blood vessels and lowering the intraocular pressure (IOP), as well as aggressive treatments like intravenous thrombolysis and Nd:YAG laser. Both thrombolysis and Nd:YAG laser treatment can improve the visual acuity of CRAO patients, but because of its lack of randomized controlled trials, further clinical studies are needed to determine their efficacy and safety. CRAO patients may have vascular embolism at other sites in the body, and may cause different degrees of cardiovascular and cerebrovascular events. The probability of secondary ocular neovascularization following the occurrence of these events is 2.5% to 31.6%. In addition to eye care, clinicians should also focus more on preventing cardiovascular and cerebrovascular events, and focus on the screening and active treatment of systemic risk factors to reduce the incidence and mortality of cardiovascular and cerebrovascular events.
ObjectiveTo observe the effect of interventional thrombolytic therapy for central retinal artery occlusion (CRAO) with ipsilateral internal carotid artery occlusion via supratrochlear artery retrogradely or external carotid artery anterogradely.MethodsNine CRAO patients (9 eyes) were enrolled in this study, including 5 males and 4 females. The mean age was (45.2±18.1) years. The mean onset duration was 24 hours. There were 4 eyes with vision of no light perception, 3 eyes with light perception and 2 eyes with hand movement. Fundus fluorescein angiography (FFA) examination showed that the retinal artery was filled with delayed fluorescence. The peak of fluorescence was seen in the anterior part of the artery, and some of the eyes showed retrograde filling. The arm-retinal circulation time (A-Rct) was ≥35 s in 4 eyes, ≥35 s - ＜25 s in 5 eyes. The filling time of retinal artery and its branches (FT) was ≥15 s in 2 eyes, ≥12 s - ＜15 s in 3 eyes, ≥9 s - ＜12 s in 4 eyes. All the patients received the treatment of interventional thrombolytic therapy via supratrochlear artery retrogradely (8 eyes) or external carotid artery anterogradely (1 eye) according to the indications and contraindications of thrombolytic therapy in acute cerebral infraction patients. Urokinase (0.4 million U in total) was intermittently injected into the arteries. After artery thrombolysis, the changes of digital subtraction angiography (DSA), filling time of retinal artery and its branches on FFA within 24 hours and the visual acuity were observed. According to the A-Rct and FT on FFA, the therapeutic effects on retinal circulation were defined as effective markedly (A-Rct≤15 s, FT≤2 s) , effective (A-Rct was improved but in the range of 16 - 20 s, FT was in 3 - 8 s) and no effect (A-Rct was improved but ≥21 s, FT≥9 s). The related local or systemic complications were recorded.ResultsAfter the injection of urokinase into the catheter, the ophthalmic artery and its branches were increased in 6 eyes (66.7%), and the development of the eye ring was significantly more than that of the eyes before thrombolysis. The circulation time in ophthalmic artery was speeded up for 2 s before thrombolysis in 3 eyes, 3 s in 3 eyes, and 4 s in 2 eyes. Within 24 hours after thrombolysis treatment, the A-Rct was significantly decreased than that of before interventional therapy. The retinal circulation was effective markedly in 4 eyes (44.4%), effective in 4 eyes (44.4%) and no effect in 1 eyes (11.2%) . The vision was improved 3 lines in 4 eyes (44.4%), 2 lines in 3 eyes (33.3%), 1 line in 1 eye (11.2%) and no change in 1 eye (11.2%). There were no abnormal eye movements, vitreous hemorrhage and incision hematoma, intracranial hemorrhage, cerebral embolism, and other local and systemic adverse effectives during the follow-up.ConclusionsThe interventional thrombolytic therapy via supratrochlear artery retrogradely or external carotid artery anterogradely for CRAO with the ipsilateral internal carotid artery occlusion can improve retinal circulation and vision. There are no related local or systemic complications.
Objective To observe the pathological changes of branch retinal artery occlusion (BRAO) by optical coherence tomography (OCT). Methods Twenty-six eyes of 26 patients with BRAO diagnosed in our Center from December 2002 to June 2005 were examined by OCT. The intervals of disease onsets and OCT examinations in all patients were within 2 weeks. The OCT scan modes were horizontal or vertical lines, and the locations of OCT scanning were macular area and the posterior pole of retina. The retinal thicknesses of macular foveola were measured and the macular thicknesses in different obstructive locations were compared using ANOVA analysis. The correlations of visual acuity and retinal thickness were analyzed by Pearson correlation analysis. Results Among the 26 eyes with BRAO, 9 eyes with temporosuperior artery occlusion, 8 eyes with temporoinferior artery occlusion, 7 eyes with arteriole occlusion and 2 eyes with retinal ciliary artery occlusion were observed. The pathological characteristics of OCT images of BRAO were increased retinal thickness and reflectivity in the obstructive locations, and widened dark area of photoreceptors (edema), while there was no obvious foveal edema were observed. The retinal images in other locations were normal. The average macular foveal thickness in the groups of temporosuperior artery occlusion, temporoinferior artery occlusion and retina arteriole occlusion were (161.11plusmn;17.66) mu;m, (148.38plusmn;18.48) mu;m and (136.29plusmn;14.94) mu;m, respectively (F=4.137,P=0.031,Pgt;0.01). There was no correlation of visual acuity with retinal thickness in 24 eyes (r＝0.285，P＝0.176，Pgt;0.01). Conclusion OCT could display the pathological changes of retinal tissue of BRAO in vivo. The increases of macular foveal thicknesses in BRAO eyes are not so obvious, and no correlations could be seen between visual acuity and macular foveal thickness. OCT is indicated on the old patients and the patients with systemic diseases for whom FFA is contraindicated. The unique characteristics of pathological changes of BRAO indicated by OCT images supply the objective signs for the instant clinical diagnosis. (Chin J Ocul Fundus Dis, 2007, 23: 173-176)