Authors: Ying Wang, Yong Liu, Xiaotang Wang

Author Disclosure Block: Y. Wang: None. Y. Liu: None. X. Wang: None.

Abstract Body:

Purpose: Central retinal artery occlusion (CRAO), an ocular stroke, causes severe and permanent visual impairment. Once thecentral retinal artery is occluded, irreversible apoptosis of the retina occurs depending on the duration of retinal ischemia. Certainly,there is no consensus about optimal or standard therapeutic treatment for CRAO endorsed by ophthalmological guidelines.Intravenous thrombolysis with recombinant tissue-type plasminogen activator (rt-PA) has been extensively applied in the treatment ofCRAO with the proven advantages of feasibility and safety. This study aimed to assess the efficacy of intravenous rt-PAthrombolysis for the management of CRAO by evaluating the pooled evidence.

Study Design: Meta - analysis.

Methods: A comprehensive literature search of electronic databases including PubMed, OVID, and Cochrane Library was conductedup to and including March 2019. All studies reporting visual outcomes after CRAO (with thrombolytic therapy) were collected.Patient-level data on visual acuity (VA) and adverse events were recorded and assessed in this analysis. Data were inputted into thestatistical software of STATA. The studies were weighted by the inverse of the variance and merged in a random-effects model.

Results: The systematic review process yielded seven eligible studies including 121 patients with CRAO who received theintravenous rt-PA treatment. 62 patients showed improvement in VA (52.0%; 95% CI, 34.0%>70.0%) following rt-PA intravenousthrombolytic therapy. The observed improvement rate in the intravenous rt-PA treatment group was significantly higher than theconservative treatment group (40.4% vs. 13.0%; OR, =5.16; 95% CI, 1.90-14.05). The incidence rate of complications was relativelylow (11 out of the 121 patients). Hemorrhage (9/11) was the major reported complication. Mortality was zero.

Conclusions: This meta - analysis indicated that intravenous rt-PA thrombolysis could be an effective and safe strategy for themanagement of CRAO. However, a more detailed large-scale clinical trial is warranted to strengthen the evidence-based therapeuticguidance.