动脉内溶栓治疗视网膜中央动脉阻塞患者的临床特征及功能性视觉恢复单中心研究OACSTPCD

Objective To investigate the clinical characteristics and functional visual recovery of patients with central retinal artery occlusion(CRAO)treated with intra-arterial thrombolysis(IAT). Methods The non-arteriotic CRAO patients admitted to the Department of Neurology and Neuro-ophthalmology of the First Affiliated Hospital of Northwest University from January 2018 to August 2023 were included.They were divided into IAT group and non-IAT group according to whether IAT was performed after admission.Functional vision is defined as visual acuity ≥20/100.The clinical features and functional visual recovery at different time periods(admission,discharge and 1 month after discharge)were compared and analyzed between the two groups. Results A total of 131 patients(131 eyes)with non-arteriotic CRAO were included,including 93 males(71.0％)with a mean age of(61.6±12.6)years.There were 57 patients(43.5％)in IAT group and 74 patients(56.5％)in non-IAT group.Compared with patients in non-IAT group,patients in IAT group had younger age[(58.4±12.5)years vs.(64.1±12.2)years,P=0.011],lower proportion of stroke history[10(17.5％)vs.25(33.8％),P=0.037],shorter time from onset to visit[10.0(6.0-24.0)h vs.55.0(20.2-162.0)h,P＜0.001],higher proportion of onset after awakening[26(45.6％)vs.15(20.3％),P=0.002]and better internal carotid artery status on the affected side(none-stenosis∶mild stenosis∶moderate-severe stenosis∶occlusion=41∶7∶7∶2 vs.32∶11∶21∶10,P=0.006).The proportion of functional vision at 1 month after discharge was higher in IAT group than that in non-IAT group[25(43.9％)vs.18(24.3％),P=0.018],but there was no statistically significant difference in other time periods(admission and discharge)(P＞0.05).Multivariate logistic regression analysis showed that the functional vision of CRAO patients in the IAT group at 1 month after discharge was significantly improved compared with those in the non-IAT group(OR 3.24,95％CI 1.08-9.69,P=0.036).In the IAT group,ophthalmic artery spasm occurred in 2 cases(3.5％),skin bleeding at the puncture site in 2 cases(3.5％),and new cerebral embolism(all asymptomatic embolism)occurred in 4 cases(7.0％). Conclusions Some clinical features of CRAO patients who were treated with or without IAT were different.IAT can significantly improve the functional vision of CRAO patients at 1 month after discharge,and the surgical safety is good.This suggests that clinicians should pay more attention to IAT in CRAO patients in order to improve their visual function.