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Improved visual outcomes of central retinal artery occlusion with local intra-arterial fibrinolysis beyond the conventional time window

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Abstract

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.

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Data availability

Anonymized data that is not presented in this article may be made available upon reasonable request to qualified researchers for the purposes of reproducing the study procedures and results.

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Acknowledgements

We express our gratitude to Dr. Mingchang Li, Dr. Shenqi Zhang and Dr. Jianming Liao for performing the LIF procedure for CRAO patients. We thank all the patients who participated in the study.

Funding

This study was funded by Key Research and Development Project of Hubei Province (2022BCA009) to Xuan Xiao, Wuhan University Specific Fund for Major School-level Internationalization Initiatives (WHUGJZDZX-PT02) to Xuan Xiao and Key Laboratory Open Project of Hubei Province (2021KFY056) to Ting Chen.

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Author notes

  1. Xuejie Li and Ting Chen contributed to the paper equally.

Authors and Affiliations

  1. Department of Ophthalmology, Renmin Hospital of Wuhan University, No. 238 Jiefang Road, Wuhan, 430060, Hubei, China

    Xuejie Li, Ting Chen, Ying Li, Chuansen Wang, Yuedan Wang, Yuwei Wan, Anhuai Yang & Xuan Xiao

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  1. Xuejie Li
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  2. Ting Chen
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  4. Chuansen Wang
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Contributions

Conceptualization: XL, TC, AY, XX; Data curation: XL, TC, CW; Funding acquisition: XX; Investigation: YL, CW, AY; Methodology: XL, YL, YW, YW; Project administration: XX; Resources: YL, YW, YW; Supervision: TC, XX; Visualization: CW, YW, YW; Writing—original draft: XL, TC; Writing—review and editing: XL, YL, CW, AY, XX. All authors have read and agreed to the published version of the manuscript.

Corresponding authors

Correspondence to Anhuai Yang or Xuan Xiao.

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Ethical approval

The study was approved by the Institutional Review Board of Renmin Hospital of Wuhan University (2020-X-58 and WDRY2022-K278).

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All participants gave written informed consent before participation, according to the Declaration of Helsinki.

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Li, X., Chen, T., Li, Y. et al. Improved visual outcomes of central retinal artery occlusion with local intra-arterial fibrinolysis beyond the conventional time window. J Thromb Thrombolysis 57, 503–511 (2024). https://doi.org/10.1007/s11239-023-02927-2

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