Safety and effectiveness of IV Thrombolysis in retinal artery occlusion: A multicenter retrospective cohort study
Philipp Baumgartner, Lucas Kook, Valerian Altersberger, Henrik Gensicke, Elena Ardila-Jurado, Georg Kägi, Alexander Salerno, Patrik Michel, Kiran M. Gopisingh, Paul J. Nederkoorn, Jan F. Scheitz, Christian H. Nolte, Mirjam R. Heldner, Marcel Arnold, Charlotte Cordonnier, Lucie Della Schiava, Christian Hametner, Peter A. Ringleb, Ronen R. Leker, Hamza Jubran, Andreas R. Luft, Stefan T. Engelter, Susanne Wegener, For the Thrombolysis in Stroke Patients (TRISP) Collaborators
Abstract
BACKGROUND: Retinal artery occlusion (RAO) may lead to irreversible blindness. For acute RAO, intravenous thrombolysis (IVT) can be considered as treatment. However, due to the rarity of RAO, data about IVT safety and effectiveness is limited. METHODS: From the multicenter database ThRombolysis for Ischemic Stroke Patients (TRISP), we retrospectively analyzed visual acuity (VA) at baseline and within 3 months in IVT and non-IVT treated RAO patients. Primary outcome was difference of VA between baseline and follow up (∆VA). Secondary outcomes were rates of visual recovery (defined as improvement of VA ⩾ 0.3 logMAR), and safety (symptomatic intracranial hemorrhage (sICH) according to ECASS II criteria, asymptomatic intracranial hemorrhage (ICH) and major extracranial bleeding). Statistical analysis was performed using parametric tests and a linear regression model adjusted for age, sex and baseline VA. RESULTS: < 0.05). No significant differences in ∆VA and visual recovery rate were found between groups at follow up. Two asymptomatic ICH (4%) and one (2%) major extracranial bleeding (intraocular bleeding) occurred in the IVT group, while no bleeding events were reported in the non-IVT group. CONCLUSION: Our study provides real-life data from the largest cohort of IVT treated RAO patients published so far. While there is no evidence for superiority of IVT compared to conservative treatment, bleeding rates were low. A randomized controlled trial and standardized outcome assessments in RAO patients are justified to assess the net benefit of IVT in RAO.