Abstract W P67: Defining A Therapeutic Window For Successful Intravenous Fibrinolytic Therapy In Central Retinal Artery Occlusion: A Subject Level Meta-analysis
Central retinal artery occlusion (CRAO) is an ophthalmologic emergency which results in blindness in a high percentage of affected patients. A wide variety of treatment methods have been proposed to manage the resulting retinal ischemia; however, all but fibrinolysis have proven unsuccessful and fibrinolytic therapy, while promising, remains of unproven and controversial benefit. The purpose of the current analysis is to assemble the published literature on systemic fibrinolysis in CRAO at the subject level and compare the results against the natural history of this illness to determine a time-window of clinical effectiveness of fibrinolytic interventions for use in future clinical trials. Subject level data was obtained for 157 cases. We conclude that systemic fibrinolysis is likely to be beneficial in the first 4.5 hours after symptom onset (odds ratio 3.5 [95% confidence interval 1.8 to 6.9, p<0.001], 31.4% relative risk reduction with a number need to treat of 3.9 [95% confidence interval 2.4 to 10.7). We argue that a clinical trial of fibrinolytic therapy for CRAO in this time window is likely to be successful. Interestingly, we also found that the conventional treatment with ocular massage, hemodilution and/or anterior chamber paracentesis significantly worsen visual acuity outcomes after central retinal artery occlusion.
Author Disclosures: M. Schrag: None. T. Youn: None. J. Schindler: None. H. Kirshner: None. D.M. Greer: None.
- © 2015 by American Heart Association, Inc.