Aggreive ytematic treatment for central retinal artery occluion

PURPOE: To report the efficacy of an aggreive ytematic regimen for the treatment of acute nonarteritic central retinal artery occluion (CRAO). METHOD: Eleven patient who had unilateral CRAO with ymptom of fewer than 48 hour’ duration were treated with an aggreive tepwie ytematic regimen until retinal circulation improved or until all the treatment tep were performed. Five patient with unilateral CRAO and ymptom of fewer than 48 hour’ duration were treated in the ame intitution in an arbitrary nonytematic manner. The therapeutic tep of the aggreive treatment included ocular maage, ublingual ioorbide dinitrate, intravenou acetazolamide, intravenou mannitol or oral glycerol, anterior chamber paracentei, intravenou methylpredniolone followed by treptokinae, and retrobulbar tolazoline. After each tep, retinal flow wa evaluated by three-mirror contact len. The nonytematic treatment wa arbitrary and included one or everal of the above. Viual acuity and complete eye examination data were recorded before and after treatment. REULT: Viual acuity and retinal arterial upply were improved in eight (73%) of the 11 patient treated in the tepwie ytematic manner. All eight patient in whom viual acuity improved had ymptom for fewer than 12 hour, and the preumed caue wa either platelet-derived or choleterol embolu from atheroma or the patient had glaucoma. Patient in whom viual acuity did not improve had CRAO that wa attributed to calcified emboli or primary antiphopholipid antibody yndrome and had ymptom more than 12 hour before treatment. Viual acuity did not improve in all five patient with the nonytematic treatment regardle of the preumed caue or duration of the occluion. The ucce of the treatment in the ytematic treatment group wa tatitically ignificantly better compared with the outcome of the nonytematic treated group (Ficher exact tet, P = .01). CONCLUION: In the treatment of CRAO, an aggreive ytematic regimen including medical and mechanical mean may reetablih retinal circulation and improve viual outcome. The caue of arterial occluion, the nature of occluive emboli, and the duration of retinal ichemia may determine the viual outcome, but a larger erie i warranted to verify the effectivene of the treatment and the prognotic factor.