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lüll Local intra-arterial fibrinolysis for acute occlusion of the central retinal artery: a meta-analysis of the published data Beatty S; Au Eong KGBr J Ophthalmol 2000[Aug]; 84 (8): 914-6BACKGROUND/AIM: Central retinal artery occlusion (CRAO) is typically associated with a poor visual outcome. Several favourable reports of local intra-arterial fibrinolysis (LIF), which involves the superselective administration of a thrombolytic agent directly into the ophthalmic artery, have appeared in the recent literature. The aim of this study was to critically appraise these studies in a collective fashion. METHODS: A meta-analysis was performed of all the published literature germane to LIF in cases of CRAO. RESULTS: Of the 16 studies identified, all were retrospective and non-randomised. After correction for data duplication, the results of LIF in 100 patients can be reported. A final acuity of 6/6 or better was seen in 14% of patients following LIF, and a visual result of 6/12 or better was seen in 27% of subjects. A poor final acuity of 3/60 or worse was seen in 60.6% of eyes treated with local intra-arterial fibrinolysis. These results compare favourably with conventional forms of therapy. Potentially serious complications were seen in four patients, but no patient suffered a permanent neurological deficit. CONCLUSION: The results of this study suggest that there may be a marginal visual benefit associated with LIF compared with conventional management of CRAO. However, the methodology of the cited studies was often unsatisfactory, and a randomised controlled trial of LIF in cases of CRAO is justified. Outside of a randomised clinical trial, the use of superselective fibrinolytic therapy for CRAO cannot be recommended on the basis of current evidence.|Acute Disease[MESH]|Fibrinolytic Agents/*administration & dosage[MESH]|Humans[MESH]|Infusions, Intra-Arterial[MESH]|Injections, Intra-Arterial[MESH]|Retinal Artery Occlusion/*drug therapy/physiopathology[MESH]|Thrombolytic Therapy/*methods[MESH]|Treatment Outcome[MESH]|Visual Acuity/physiology[MESH] |