Persistent value of intra-arterial fibrinolysis 8 hours or more following central retinal artery occlusion or of its branches

To establish that intra-arterial fibrinolysis of the ophthalmic artery can still be efficient 8 hours or more after a central retinal artery occlusion. Nine to twenty hours (average 12.5 H) after a loss of vision due to a central retinal artery occlusion or the occlusion of its branches, 7 patients were treated by intra-arterial fibrinolysis. The vision of the affected eye was limited to light perception for four patients, to hand movement at 1 meter for two patients, and to 4/10 P2 for one patient. Under radiological guidance, 300.000 IU of urokinase was injected through a microcatheter placed in the ophthalmic artery (6 patients), or in the facial artery (1 patient); in this case the angiogram showed an occlusion of the internal carotid artery and a retrograde filling of the ophthalmic artery through the facial artery. We did not observed any complication. The 3 patients who had a vision better than light perception recovered a vision of 10/10 P2. For the others: two patients recovered a vision of 9/10 P2 and 5/10 P2, two did not recover. Fibrinolysis of the ophthalmic artery must ideally be performed as soon as possible, but a recovery is still possible more than 8 hours after the onset of the loss of vision. The time limit is not yet defined but after 24 hours, the chance of improvement seems to be very low.