Comparison of thrombolysis and conservative management in acute retinal ischaemia
Reviewed by Lauren Hepworth

The authors present a retrospective cohort study of individuals presenting with acute, painless, monocular vision loss and diagnosed with acute retinal ischaemia. Reasons for exclusion were iatrogenic aetiology, transient vision loss, missing initial visual acuity data, more than 16 hours since symptom onset, present of retinal vein occlusion, and hyperbaric oxygen received. The analysis divided participants into two groups, those receiving intra-arterial thrombolysis and those receiving conservative management (including ocular massage, agents to reduce intraocular pressure or antiplatelets). The following data was extracted from the medical records; demographics, affected eye, comorbidities, time to needle, dosage, best corrected visual acuity (BCVA) and adverse events. The primary outcome was BCVA at one week and final visit after treatment. A 0.3 LogMAR improvement was deemed clinically significant. A total of 53 individuals were included in the study from 121 screened. Twenty-three of these received thrombolysis. This group was significantly younger and had a lower prevalence of diabetes, peripheral vascular disease, smoking and alcohol use than the conservative treatment group. Mean time from symptom onset to thrombolysis was nine hours. BCVA across the two groups was similar at the initial visit. Improvement was only seen in the thrombolysis group at one-week follow-up. Both groups demonstrated BCVA improvement at the final visit, however the thrombolysis group had significantly more participants reach the threshold of clinical significant change. A single adverse event of a retinal haemorrhage was reported. The authors acknowledge limitations of the study including small sample size, non-randomised methodology. This study suggests that thrombolysis is associated with a better improvement of visual acuity. A more robust study with a randomised controlled trial design is required to enable more definite conclusion.

Intra-arterial thrombolysis for acute retinal ischemia: a retrospective, observational cohort study.
Gao Y, Zhao W, Wu D, et al.
JOURNAL OF NEURO-OPHTHALMOLOGY
2023;43:202–8.