Successful Treatment of Central Retinal Artery Occlusion With Tissue Plasminogen Activator Followed by Recurrent Retinal Ischemia

• Published in: Journal of vitreoretinal diseases (Print) 2024-09, Vol.8 (5), p.622-626
• Main Authors: Hsu, Jerry, Brown, Jeffrey, Mallick, Adnan, Fara, Michael, De Leacy, Reade, Rosen, Richard B., Ginsburg, Robin N., Lema, Gareth M.C.
• Format: Article
• Language: English
• ISSN: 2474-1264; 2474-1272; 2474-1272
• DOI: 10.1177/24741264241267376

Purpose: To describe the use of intra-arterial tissue plasminogen activator (tPA) to treat central retinal artery occlusion (CRAO). Methods: A case and its findings were analyzed. Results: A 45-year-old man diagnosed with a CRAO and had cerebral angiography and treatment with intra-arterial tPA. After treatment, follow-up included optical coherence tomography (OCT), fundus photography, fluorescein angiography, and OCT angiography. The visual acuity (VA) improved from hand motions to 20/30 immediately after fibrinolysis. A vascular occlusion event the next day resulted in a decrease in VA to 20/400. After initiation of dual antiplatelet therapy, the patient’s VA improved to 20/20. As the retina recovered, the evolution of retinal ischemic changes to a finding similar to paracentral acute middle maculopathy was seen on imaging. Conclusions: This is the first report describing a patient safely started on dual antiplatelet therapy that led to vision improvement after initial treatment with intra-arterial tPA for a CRAO resulted in recurrent vision loss.