Local intra-arterial fibrinolysis (LIF) is a promising therapeutic option for CRAO. However, the narrow time window of 6 h has greatly limited the application of LIF. In this study, we explored the efficacy of LIF beyond the conventional time windows and compared the result with conservative therapy. This prospective study included 179 CRAO patients with baseline visual acuity (VA) ≤ 20/400 treated at Renmin Hospital of Wuhan University. The mean time from vision loss to presentation was 5.5 days. 58 patients received conventional standard therapy (CST) alone.121 patients underwent LIF. Main outcome was VA improvement ≥ 0.3 logMAR. Secondary outcome was a favorable VA outcome of 20/200 or better. Logistic regressions were performed to identify predictors of visual improvement. 43% patients in the LIF group experienced VA improvement versus 19% with CST (P = 0.002). LIF was associated with 4.0-fold higher likelihood of visual improvement compared to CST (P = 0.001). Poor baseline VA (light perception or no light perception) and shortened prothrombin time (PT) were associated with greater chance of visual improvement with LIF. However, LIF showed no significant advantage over CST for favorable VA outcomes. No major complications occurred. LIF beyond the therapeutic time window improved vision in functionally blind CRAO patients and showed better efficacy when compared with CST. PT may be a potential predictor of visual outcome after LIF. Our findings could complement existing time-based treatment guidelines and potentially allow for personalized decisions on the use of LIF beyond time windows.

局部动脉内纤溶（LIF）是 CRAO 的一种有前途的治疗选择。然而，6小时的狭窄时间窗口极大地限制了LIF的应用。在本研究中，我们探讨了 LIF 超出常规时间窗的疗效，并将结果与​​保守治疗进行了比较。这项前瞻性研究纳入了 179 名在武汉大学人民医院接受治疗、基线视力 (VA)≤≤20/400 的 CRAO 患者。从视力丧失到出现视力的平均时间为 5.5 天。 58 名患者仅接受常规标准治疗 (CST)。121 名患者接受了 LIF。主要结果是 VA 改善 ≥ 0.3 logMAR。次要结果是 20/200 或更好的 VA 结果。进行逻辑回归以确定视力改善的预测因素。 LIF 组中 43% 的患者视力得到改善，而 CST 组中这一比例为 19%（P = 0.002）。与 CST 相比，LIF 与视力改善的可能性高出 4.0 倍 (P = 0.001)。基线 VA（光感或无光感）差和凝血酶原时间 (PT) 缩短与 LIF 视力改善的机会更大相关。然而，在 VA 结果方面，LIF 与 CST 相比并没有显着优势。没有发生重大并发症。超过治疗时间窗的 LIF 改善了功能性失明 CRAO 患者的视力，并且与 CST 相比显示出更好的疗效。 PT 可能是 LIF 后视力结果的潜在预测指标。我们的研究结果可以补充现有的基于时间的治疗指南，并有可能允许在时间窗口之外使用 LIF 进行个性化决策。