Visual outcomes of central retinal artery occlusion: Exploring treatment strategies beyond the conventional time window

• Published in: Journal of stroke and cerebrovascular diseases Vol. 34; no. 3; p. 108240
• Main Authors: Yang, Chi-Chun, Weng, Chang-Chi, Chou, Yu-Bai, Huang, Yi-Ming, Hwang, De-Kuang, Chen, Shih-Jen, Lin, Tai-Chi
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.03.2025
• Subjects: Adult; Aged; Aged, 80 and over; Beyond treatment window; Central retinal artery occlusion; Conservative Treatment - adverse effects; Female; Fibrinolytic Agents - administration & dosage; Fibrinolytic Agents - adverse effects; Humans; Hyperbaric oxygen; Hyperbaric Oxygenation - adverse effects; Intra-arterial fibrinolysis; Male; Middle Aged; Recovery of Function; Retinal Artery Occlusion - diagnosis; Retinal Artery Occlusion - physiopathology; Retinal Artery Occlusion - therapy; Retrospective Studies; Thrombolytic Therapy - adverse effects; Time Factors; Time-to-Treatment; Treatment Outcome; Visual Acuity; Central retinal artery occlusion; Beyond treatment window; Hyperbaric oxygen; Intra-arterial fibrinolysis
• ISSN: 1052-3057; 1532-8511; 1532-8511
• DOI: 10.1016/j.jstrokecerebrovasdis.2025.108240

•CRAO is a vision-devastating emergency. However, widely-acknowledged treatment consensus is lacking and prehospital delays commonly occur (>1 day), which underscores the need to explore outcomes of treatments initiated beyond the conventional window.•Patients starting HBO therapy over 6 days after symptom onset still achieved better visual outcomes than the CT group at 6-, 12-month, and final visits (logMAR change: −0.4 vs. 0.0, P = 0.023), a novel finding not proposed before.•Subjects receiving delayed LIF still showed more visual improvement over time than the CT group (logMAR change: −0.3 vs. 0.0, P > 0.05), but the difference was insignificant.•Prevalent prehospital delays and lack of management codes restricted the application of existing treatments. Hence, our study provided real-world evidence for outcomes of LIF and HBO beyond the conventional window.•The analysis revealed that delayed HBO therapy remained more effective in preserving vision than CT, which had not been indicated in prior research. Central retinal artery occlusion (CRAO) is a vision-devastating emergency. However, widely-acknowledged treatment consensus is lacking and prehospital delays commonly occur. Hence, we aimed to investigate the visual outcomes of conservative treatments (CT), local intra-arterial fibrinolysis (LIF) and hyperbaric oxygen (HBO) therapy for non-arteritic CRAO (NA-CRAO) patients beyond the conventional time window. This retrospective comparative study included 99 NA-CRAO patients followed up for over 6 months. The subjects were divided into three groups: the CT (50 patients), LIF (10 patients) and HBO group (39 patients). The primary endpoint was the best-corrected visual acuity (BCVA) change at 6 months compared to baseline. The secondary endpoint was the improvement in BCVA at 1 year and final visits. No heterogeneity regarding demographics was identified. However, the HBO group had a more extended time-to-treatment period (median 6.0 days) and more advanced-stage CRAO cases (41 % stage III) than the CT (median 4.0 days, 14 % stage III) and LIF (median 0.6 days, 20 % stage III) groups. Despite this, the HBO group exhibited a significantly greater BCVA and a higher proportion of patients achieving significant vision improvement than those in the CT group at 6-, 12-month and final exams (51.3 % vs. 24.0 %, P < 0.05). The LIF appeared to improve outcomes more than CT over time without significance. Our study provided a concurrent comparison across 3 approaches and demonstrated that HBO therapy beyond the time window remained more effective in improving vision than CT alone for NA-CRAO patients, which had not been proposed by prior studies.