Intravenous thrombolysis with urokinase for central retinal artery occlusion in 115 patients

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Author:
WANG Run-sheng(Department of Ophthalmology, The Fourth Hospital of Xian, Xian 710004,China)
L(U) Pei-lin()
ZHANG Ya-ping(Department of Ophthalmology, The Fourth Hospital of Xian, Xian 710004,China)
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Journal Title:
Chinese Journal of Ocular Fundus Diseases
Issue:
Volume 28, Issue 05, 2012
DOI:
10.3760/cma.j.issn.1005-1015.2012.05.009
Key Word:
Retinal artery occlusion/drug therapy; Urinary plasminogen activator/therapeutic use;Urinary plasminogen activator/administration & dosage

Abstract: Objective To observe the effects of intravenous thrombolysis with urokinase for centralretinal artery occlusion (CRAO).Methods A total of 115 CRAO patients diagnosed by fluorescence fundus angiography (FFA) were enrolled in this study.The patients included 61 males and 54 females,with a mean age of (56.7±15.2) years (from 41 to 75 years).The duration ranged from 1 to 30 days.All the patients were affected unilaterally.All the patients were received the treatment of intravenous thrombolysis with urokinase (3000 U/kg,two times per day,continuous treatment for six to seven days) and retrobulbar injection of dexamethasonc 2.5 mg (one time per day,continuous treatment for 14 days).Following that,1.2 mg/kg brain protein hydrolysate (nerve nutrition) and 360 mg troxerutin (vasodilator) were given by intravenous drip (one time per day,continuous treatment for 14 days).Effectiveness of the thrombolytic and subsequent treatments including the recovery of vision and retinal arterial filling time before and after treatment were observed.Comparing the visual acuity of post treatment and pre-treatment,improving three lines or more is considered as effective markedly,improving two lines as effective,no change or a decline as no effect.With FFA as the retinal circulation recovery index,the arm-retinal circulation time (A-Rct) ≤ 15s and all branches of central retinal artery were filled with fluorescence within 2s filling (normal) as effective markedly; A-Rct improved but was in 15~20s range,all branches of central retinal artery were filled with fluorescence within 3~ 8s as effective; A Rct improved but was still ≥ 21s,all branches of central retinal artery were filled with fluorescence within ≥9s as no effect.The relationship between age,gender,the disease course,subsequent treat time and curative effectiveness were analyzed.Results There were 79 patients were examined for FFA again after thromholysis treatment which including 11 patients with complete obstruction and 68 patients with incomplete obstruction.In 11 patients with complete obstruction,eight patients showed that optic disc vascular retrograde filling disappeared,A Rct was 28-54s,and the filling time from retinal artery to tip was18-55s; three patients showed persistent optic disc vascular retrograde filling within 3-4 minutes of FFA.In 68 patients with incomplete obstruction,A-Ret returned to normal in 35 patients (51.4%),effective in 18 patients (26.5%) and no effect in 15 patients (22.1%).Retinal circulation time was shorter than that before thrombolysis treatment (x2 =11.4,P<0.05).Comparison of distribution of visual acuity before and after thrombolysis treatment,the difference was statistically significant (x2=12.1,P<0.05).Comparison of distribution of final visual acuity after subsequent treatment with that of after thrombolysis treatment,48 eyes improved two lines or more,the efficiency was 41.7%,the difference was statistically significant (x2 =14.6,P<0.05).Comparison to that of before treatment,vision changes showed effect markedly in 58 patients (50.4%),effective in 35 patients (30.4%),no effect in 22 patients (19.2%),the difference was statistically significant (x2 =44.5,P<0.05).Comparison the average age to that of effective,valid and invalid patients,the difference was not statistically significant (t=0.98,1.17,0.55; P>0.05).There was no relationship between effectiveness and gender (x2=2.6,P>0.05).In 76 patients with duration within seven days,43 patients were effective markedly and 22 patients were effective,the efficiency was 85.5%.In 25 patients with duration of 8-15 days,11 patients were effective markedly and eight patients were effective,the efficiency was 76.0%.In 34 patients who received subsequent treatment 8-14 days,18 patients were effective markedly and nine patients were effective,the efficiency was 79.4%.In 51 patients who received subsequent treatment 15-21 days,27 patients were effective markedly and 18 patients were effective,the efficiency was 88.2%.Conclusion Intravenous thrombolysis with urokinase was effective in the treatment of CRAO.

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