VIsion Salvage Using Intra-Ophthalmic Arterial Alteplase Combine with Nimodipine in Central Retinal Artery Occlusion (VISION)

Abstract

Chai Kobkitsuksakul,1 Nasathapot Namphol,1 Bandit Sirilert,1 Thanaporn Kritfuangfoo,2 Ekachat Chanthanaphak,1 Mungkorn Apirakkan,1 Kittiphop Somboonnithiphol,1 Surawan Boonyakarnkul,1 Peerapong Lueangapapong,3 Thitiporn Thongborisuth,2 Tharikarn Sujirakul2 1Division of Interventional Neuroradiology, Department of Radiology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; 2Department of Ophthalmology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; 3Department of Neurosurgery, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, ThailandCorrespondence: Tharikarn Sujirakul, Department of Ophthalmology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270 Thanon Rama VI, Thung Phaya Thai, Ratchathewi, Bangkok, 10400, Thailand, Tel [phone], Fax [phone], Email [email protected]: To investigate the efficacy and safety of selective intra-ophthalmic arterial combined nimodipine and alteplase infusion in patients with central retinal artery occlusion (CRAO).Design: Non-randomized, prospective interventional study.Methods: All patients with CRAO who presented at our institute within 24 hours from CRAO onset from August 2020 to July 2022 were included. Intra-arterial nimodipine and alteplase were given selectively into the ophthalmic artery. Visual acuity was recorded during and after the procedure. Change in best corrected visual acuity (BCVA) 1 month post-treatment, relative to baseline, was set as the primary outcome measure. Significant improvement in vision and adverse events are reported as secondary outcomes.Patients: Nine patients with non-arteritic CRAO were enrolled.Results: A total of nine patients with CRAO underwent selective intra-ophthalmic arterial nimodipine and alteplase injection. Overall, BCVA had statistically significantly improved by 0.78 logarithm of the minimum angle of resolution (logMAR) at 1 month compared with baseline (95% confidence interval: (− 1.24, − 0.31), p-value = 0.001). Seven (77.8%) patients had significant visual improvement (≥ 0.3 logMAR) at 1-month post-treatment. There were minor adverse events during administration of the nimodipine, including chemosis and headache, which resolved after the discontinuation of nimodipine. There were also asymptomatic thromboembolic events in 2 patients (22.2%) after the intervention procedure, without any morbidity or mortality.Conclusion: The use of selective intra-ophthalmic arterial combined nimodipine and alteplase was efficacious in improving BCVA at 1 month for patients with non-arteritic CRAO presenting between 24 hours from onset, with minor adverse events but no serious adverse events.Keywords: central retinal artery occlusion, thrombolysis, intra-ophthalmic arterial thrombolysis

Keywords

• central retinal artery occlusion
• thrombolysis
• intra-ophthalmic arterial thrombolysis