Improved visual outcomes of central retinal artery occlusion with local intra-arterial fibrinolysis beyond the conventional time window
© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature..
Local intra-arterial fibrinolysis (LIF) is a promising therapeutic option for CRAO. However, the narrow time window of 6 h has greatly limited the application of LIF. In this study, we explored the efficacy of LIF beyond the conventional time windows and compared the result with conservative therapy. This prospective study included 179 CRAO patients with baseline visual acuity (VA) ≤ 20/400 treated at Renmin Hospital of Wuhan University. The mean time from vision loss to presentation was 5.5 days. 58 patients received conventional standard therapy (CST) alone.121 patients underwent LIF. Main outcome was VA improvement ≥ 0.3 logMAR. Secondary outcome was a favorable VA outcome of 20/200 or better. Logistic regressions were performed to identify predictors of visual improvement. 43% patients in the LIF group experienced VA improvement versus 19% with CST (P = 0.002). LIF was associated with 4.0-fold higher likelihood of visual improvement compared to CST (P = 0.001). Poor baseline VA (light perception or no light perception) and shortened prothrombin time (PT) were associated with greater chance of visual improvement with LIF. However, LIF showed no significant advantage over CST for favorable VA outcomes. No major complications occurred. LIF beyond the therapeutic time window improved vision in functionally blind CRAO patients and showed better efficacy when compared with CST. PT may be a potential predictor of visual outcome after LIF. Our findings could complement existing time-based treatment guidelines and potentially allow for personalized decisions on the use of LIF beyond time windows.
| Medienart: |
E-Artikel |
|---|
| Erscheinungsjahr: |
2024 |
|---|---|
| Erschienen: |
2024 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:57 |
|---|---|
| Enthalten in: |
Journal of thrombosis and thrombolysis - 57(2024), 3 vom: 14. März, Seite 503-511 |
| Sprache: |
Englisch |
|---|
| Beteiligte Personen: |
Li, Xuejie [VerfasserIn] |
|---|
| Links: |
|---|
| Themen: |
Central retinal artery occlusion |
|---|
| Anmerkungen: |
Date Completed 26.03.2024 Date Revised 26.03.2024 published: Print-Electronic Citation Status MEDLINE |
|---|
| doi: |
10.1007/s11239-023-02927-2 |
|---|
| funding: |
|
|---|---|
| Förderinstitution / Projekttitel: |
|
| PPN (Katalog-ID): |
NLM366055224 |
|---|
| LEADER | 01000caa a22002652 4500 | ||
|---|---|---|---|
| 001 | NLM366055224 | ||
| 003 | DE-627 | ||
| 005 | 20240326235135.0 | ||
| 007 | cr uuu---uuuuu | ||
| 008 | 231227s2024 xx |||||o 00| ||eng c | ||
| 024 | 7 | |a 10.1007/s11239-023-02927-2 |2 doi | |
| 028 | 5 | 2 | |a pubmed24n1348.xml |
| 035 | |a (DE-627)NLM366055224 | ||
| 035 | |a (NLM)38114857 | ||
| 040 | |a DE-627 |b ger |c DE-627 |e rakwb | ||
| 041 | |a eng | ||
| 100 | 1 | |a Li, Xuejie |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Improved visual outcomes of central retinal artery occlusion with local intra-arterial fibrinolysis beyond the conventional time window |
| 264 | 1 | |c 2024 | |
| 336 | |a Text |b txt |2 rdacontent | ||
| 337 | |a ƒaComputermedien |b c |2 rdamedia | ||
| 338 | |a ƒa Online-Ressource |b cr |2 rdacarrier | ||
| 500 | |a Date Completed 26.03.2024 | ||
| 500 | |a Date Revised 26.03.2024 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a © 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature. | ||
| 520 | |a Local intra-arterial fibrinolysis (LIF) is a promising therapeutic option for CRAO. However, the narrow time window of 6 h has greatly limited the application of LIF. In this study, we explored the efficacy of LIF beyond the conventional time windows and compared the result with conservative therapy. This prospective study included 179 CRAO patients with baseline visual acuity (VA) ≤ 20/400 treated at Renmin Hospital of Wuhan University. The mean time from vision loss to presentation was 5.5 days. 58 patients received conventional standard therapy (CST) alone.121 patients underwent LIF. Main outcome was VA improvement ≥ 0.3 logMAR. Secondary outcome was a favorable VA outcome of 20/200 or better. Logistic regressions were performed to identify predictors of visual improvement. 43% patients in the LIF group experienced VA improvement versus 19% with CST (P = 0.002). LIF was associated with 4.0-fold higher likelihood of visual improvement compared to CST (P = 0.001). Poor baseline VA (light perception or no light perception) and shortened prothrombin time (PT) were associated with greater chance of visual improvement with LIF. However, LIF showed no significant advantage over CST for favorable VA outcomes. No major complications occurred. LIF beyond the therapeutic time window improved vision in functionally blind CRAO patients and showed better efficacy when compared with CST. PT may be a potential predictor of visual outcome after LIF. Our findings could complement existing time-based treatment guidelines and potentially allow for personalized decisions on the use of LIF beyond time windows | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Central retinal artery occlusion | |
| 650 | 4 | |a Local intra-arterial fibrinolysis | |
| 650 | 4 | |a Treatment time window | |
| 650 | 4 | |a Visual acuity | |
| 650 | 7 | |a Fibrinolytic Agents |2 NLM | |
| 650 | 7 | |a Tissue Plasminogen Activator |2 NLM | |
| 650 | 7 | |a EC 3.4.21.68 |2 NLM | |
| 700 | 1 | |a Chen, Ting |e verfasserin |4 aut | |
| 700 | 1 | |a Li, Ying |e verfasserin |4 aut | |
| 700 | 1 | |a Wang, Chuansen |e verfasserin |4 aut | |
| 700 | 1 | |a Wang, Yuedan |e verfasserin |4 aut | |
| 700 | 1 | |a Wan, Yuwei |e verfasserin |4 aut | |
| 700 | 1 | |a Yang, Anhuai |e verfasserin |4 aut | |
| 700 | 1 | |a Xiao, Xuan |e verfasserin |4 aut | |
| 773 | 0 | 8 | |i Enthalten in |t Journal of thrombosis and thrombolysis |d 1994 |g 57(2024), 3 vom: 14. März, Seite 503-511 |w (DE-627)NLM094439990 |x 1573-742X |7 nnns |
| 773 | 1 | 8 | |g volume:57 |g year:2024 |g number:3 |g day:14 |g month:03 |g pages:503-511 |
| 856 | 4 | 0 | |u http://dx.doi.org/10.1007/s11239-023-02927-2 |3 Volltext |
| 912 | |a GBV_USEFLAG_A | ||
| 912 | |a GBV_NLM | ||
| 951 | |a AR | ||
| 952 | |d 57 |j 2024 |e 3 |b 14 |c 03 |h 503-511 | ||