Acute phase treatment in central retinal artery occlusion: thrombolysis, hyperbaric oxygen therapy or both?
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Acute phase treatment in central retinal artery occlusion: thrombolysis, hyperbaric oxygen therapy or both? Daniel Ferreira1,2 · Carolina Soares1,2 · João Tavares‑Ferreira3 · Tiago Fernandes4 · Rui Araújo1,2 · Pedro Castro1,2,5
© Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Central retinal artery occlusion (CRAO) is a neuro-ophthalmological emergency. There is a finite time window for acute interventions such as revascularization (e.g. intravenous thrombolysis—IVT) and retinal oxygenation (e.g. hyperbaric oxygen therapy—HBOT) therapies. Case 1: A 35-year-old female presented with CRAO in the right eye (OD) confirmed by fluorescein angiography (FA) and optical coherence tomography (OCT). She underwent 4 sessions of HBOT (100% O2 at 2.4 atmosphere absolute for 90 min). Afterwards, visual defect on the nasal field was kept but visual acuity (VA) improved from counting fingers to 1.0. Case 2: A 65-year-old male presented with CRAO in his left eye (OS) with 1.5 h of evolution. Orbital sonography and OCT confirmed the presence of an embolus and he underwent IVT with rTPA (0.9 mg/kg). VA improved from light perception to 0.1. Case 3: A 21-year-old male presented acute visual loss in his OD with 2.5 h of evolution. OCT and retinography identified CRAO. He was submitted to IVT (rTPA-0.9 mg/kg) followed by 12 sessions of HBOT. VA improved from hand motion to 1.0. Our case series depicts the approaches and possible outcomes in acute management of an infrequent, but highly morbid, cerebroretinovascular disorder. Future clinical trials are warranted to tackle current difficulties in CRAO treatment. Keywords Retinal artery occlusion · Recombinant tissue plasminogen activator · Hyperbaric oxygen therapy · Orbital ultrasonography
Highlights • Acute phase treatments for central retinal artery occlu-
sion (CRAO) include intravenous thrombolysis (IVT) and hyperbaric oxygen therapy (HBOT).
* Daniel Ferreira [email protected]‑saude.pt 1
Department of Neurology, Centro Hospitalar Universitário de São João, EPE, Porto, Portugal
2
Department of Clinic Neurosciences and Mental Health, Medical Faculty of Porto University, Porto, Portugal
3
Department of Ophthalmology, Centro Hospitalar Universitário de São João, EPE, Porto, Portugal
4
Hyperbaric Medicine Unit, Unidade Local de Saúde de Matosinhos, Porto, Portugal
5
Stroke Unit and Neurology Department, Centro Hospitalar Universitário de São João, EPE, Porto, Portugal
• Even though no guideline for acute CRAO management
is available, IVT has been proven as a beneficial treatment. • HBOT is a promising approach that presents beneficial outcomes with a time-dependent correlation. • Further investigations are needed to better clarify the safety and effectiveness of this treatments in an isolated or even combined approach.
Introduction Central retinal artery occlusion (CRAO) is considered to be the ocular analogous of a cerebral stroke and is regarded as a neuro-ophthalmological emergency. The estimated incidence is 1 in 100,000 patients/y
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