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Intravenous thrombolysis in acute central retinal artery occlusion - A prospective interventional case series

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Intravenous thrombolysis in acute central retinal artery occlusion - A prospective interventional case series. / Schultheiss, Maximilian; Härtig, Florian; Spitzer, Martin S; Feltgen, Nicolas; Spitzer, Bernhard; Hüsing, Johannes; Rupp, André; Ziemann, Ulf; Bartz-Schmidt, Karl U; Poli, Sven.

In: PLOS ONE, Vol. 13, No. 5, 2018, p. e0198114.

Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review

Harvard

Schultheiss, M, Härtig, F, Spitzer, MS, Feltgen, N, Spitzer, B, Hüsing, J, Rupp, A, Ziemann, U, Bartz-Schmidt, KU & Poli, S 2018, 'Intravenous thrombolysis in acute central retinal artery occlusion - A prospective interventional case series', PLOS ONE, vol. 13, no. 5, pp. e0198114. https://doi.org/10.1371/journal.pone.0198114

APA

Schultheiss, M., Härtig, F., Spitzer, M. S., Feltgen, N., Spitzer, B., Hüsing, J., Rupp, A., Ziemann, U., Bartz-Schmidt, K. U., & Poli, S. (2018). Intravenous thrombolysis in acute central retinal artery occlusion - A prospective interventional case series. PLOS ONE, 13(5), e0198114. https://doi.org/10.1371/journal.pone.0198114

Vancouver

Schultheiss M, Härtig F, Spitzer MS, Feltgen N, Spitzer B, Hüsing J et al. Intravenous thrombolysis in acute central retinal artery occlusion - A prospective interventional case series. PLOS ONE. 2018;13(5):e0198114. https://doi.org/10.1371/journal.pone.0198114

Bibtex

@article{d3fafadfa1ca4cbb9061c810439c2533,
title = "Intravenous thrombolysis in acute central retinal artery occlusion - A prospective interventional case series",
abstract = "BACKGROUND: No evidence-based therapy exists for non-arteritic central retinal artery occlusion (NA-CRAO). Retinal ischemic tolerance is low; irreversible damage occurs within four hours of experimental NA-CRAO. In previous randomized trials evaluating intra-arterial or intravenous thrombolysis (IVT) in NA-CRAO, only one patient was treated this early. In December 2013, the Departments of Neurology & Stroke and Ophthalmology at University Hospital Tuebingen, Germany, decided to treat patients using IVT within 4.5 hours of NA-CRAO, the therapeutic window established for ischemic stroke.MATERIALS AND METHODS: Consecutive NA-CRAO patients with severe visual loss received IVT after exclusion of intracranial hemorrhage. Follow-up was conducted at day 5 (d5) and day 30 (d30). Visual outcomes were compared to the conservative standard treatment (CST) arm of the EAGLE-trial.RESULTS: Until August 2016, 20 patients received IVT within 4.5 hours after NA-CRAO with a median onset-to-treatment time of 210 minutes (IQR 120-240). Visual acuity improved from baseline mean logarithm of the minimum angle of resolution 2.46±0.33 (SD) (light perception) to 1.52±1.09 (Snellen equivalent: 6/200) at d5 (p = 0.002) and 1.60±1.08 (Snellen equivalent: 6/240) at d30. Compared to the EAGLE CST-arm, functional recovery to reading ability occurred more frequently after IVT: 6/20 (30%) versus 1/39 (3%) at d5 (p = 0.005) and at d30 5/20 (25%) versus 2/37 (5%) (p = 0.045). Two patients experienced serious adverse events (one angioedema and one bleeding from an abdominal aortic aneurysm) but recovered without sequelae.CONCLUSIONS: IVT within 4.5 hours after symptom onset may represent an effective treatment of NA-CRAO. Randomized trials are warranted to evaluate efficacy and safety of early IVT in acute NA-CRAO.",
keywords = "Acute Disease, Aged, Female, Humans, Male, Prospective Studies, Retinal Artery Occlusion/therapy, Safety, Thrombolytic Therapy/adverse effects, Veins",
author = "Maximilian Schultheiss and Florian H{\"a}rtig and Spitzer, {Martin S} and Nicolas Feltgen and Bernhard Spitzer and Johannes H{\"u}sing and Andr{\'e} Rupp and Ulf Ziemann and Bartz-Schmidt, {Karl U} and Sven Poli",
year = "2018",
doi = "10.1371/journal.pone.0198114",
language = "English",
volume = "13",
pages = "e0198114",
journal = "PLOS ONE",
issn = "1932-6203",
publisher = "Public Library of Science",
number = "5",

}

RIS

TY - JOUR

T1 - Intravenous thrombolysis in acute central retinal artery occlusion - A prospective interventional case series

AU - Schultheiss, Maximilian

AU - Härtig, Florian

AU - Spitzer, Martin S

AU - Feltgen, Nicolas

AU - Spitzer, Bernhard

AU - Hüsing, Johannes

AU - Rupp, André

AU - Ziemann, Ulf

AU - Bartz-Schmidt, Karl U

AU - Poli, Sven

PY - 2018

Y1 - 2018

N2 - BACKGROUND: No evidence-based therapy exists for non-arteritic central retinal artery occlusion (NA-CRAO). Retinal ischemic tolerance is low; irreversible damage occurs within four hours of experimental NA-CRAO. In previous randomized trials evaluating intra-arterial or intravenous thrombolysis (IVT) in NA-CRAO, only one patient was treated this early. In December 2013, the Departments of Neurology & Stroke and Ophthalmology at University Hospital Tuebingen, Germany, decided to treat patients using IVT within 4.5 hours of NA-CRAO, the therapeutic window established for ischemic stroke.MATERIALS AND METHODS: Consecutive NA-CRAO patients with severe visual loss received IVT after exclusion of intracranial hemorrhage. Follow-up was conducted at day 5 (d5) and day 30 (d30). Visual outcomes were compared to the conservative standard treatment (CST) arm of the EAGLE-trial.RESULTS: Until August 2016, 20 patients received IVT within 4.5 hours after NA-CRAO with a median onset-to-treatment time of 210 minutes (IQR 120-240). Visual acuity improved from baseline mean logarithm of the minimum angle of resolution 2.46±0.33 (SD) (light perception) to 1.52±1.09 (Snellen equivalent: 6/200) at d5 (p = 0.002) and 1.60±1.08 (Snellen equivalent: 6/240) at d30. Compared to the EAGLE CST-arm, functional recovery to reading ability occurred more frequently after IVT: 6/20 (30%) versus 1/39 (3%) at d5 (p = 0.005) and at d30 5/20 (25%) versus 2/37 (5%) (p = 0.045). Two patients experienced serious adverse events (one angioedema and one bleeding from an abdominal aortic aneurysm) but recovered without sequelae.CONCLUSIONS: IVT within 4.5 hours after symptom onset may represent an effective treatment of NA-CRAO. Randomized trials are warranted to evaluate efficacy and safety of early IVT in acute NA-CRAO.

AB - BACKGROUND: No evidence-based therapy exists for non-arteritic central retinal artery occlusion (NA-CRAO). Retinal ischemic tolerance is low; irreversible damage occurs within four hours of experimental NA-CRAO. In previous randomized trials evaluating intra-arterial or intravenous thrombolysis (IVT) in NA-CRAO, only one patient was treated this early. In December 2013, the Departments of Neurology & Stroke and Ophthalmology at University Hospital Tuebingen, Germany, decided to treat patients using IVT within 4.5 hours of NA-CRAO, the therapeutic window established for ischemic stroke.MATERIALS AND METHODS: Consecutive NA-CRAO patients with severe visual loss received IVT after exclusion of intracranial hemorrhage. Follow-up was conducted at day 5 (d5) and day 30 (d30). Visual outcomes were compared to the conservative standard treatment (CST) arm of the EAGLE-trial.RESULTS: Until August 2016, 20 patients received IVT within 4.5 hours after NA-CRAO with a median onset-to-treatment time of 210 minutes (IQR 120-240). Visual acuity improved from baseline mean logarithm of the minimum angle of resolution 2.46±0.33 (SD) (light perception) to 1.52±1.09 (Snellen equivalent: 6/200) at d5 (p = 0.002) and 1.60±1.08 (Snellen equivalent: 6/240) at d30. Compared to the EAGLE CST-arm, functional recovery to reading ability occurred more frequently after IVT: 6/20 (30%) versus 1/39 (3%) at d5 (p = 0.005) and at d30 5/20 (25%) versus 2/37 (5%) (p = 0.045). Two patients experienced serious adverse events (one angioedema and one bleeding from an abdominal aortic aneurysm) but recovered without sequelae.CONCLUSIONS: IVT within 4.5 hours after symptom onset may represent an effective treatment of NA-CRAO. Randomized trials are warranted to evaluate efficacy and safety of early IVT in acute NA-CRAO.

KW - Acute Disease

KW - Aged

KW - Female

KW - Humans

KW - Male

KW - Prospective Studies

KW - Retinal Artery Occlusion/therapy

KW - Safety

KW - Thrombolytic Therapy/adverse effects

KW - Veins

U2 - 10.1371/journal.pone.0198114

DO - 10.1371/journal.pone.0198114

M3 - SCORING: Journal article

C2 - 29813111

VL - 13

SP - e0198114

JO - PLOS ONE

JF - PLOS ONE

SN - 1932-6203

IS - 5

ER -