Treatments for acute central retinal artery occlusion (blockage of the blood supply to the retina of the eye)

Fraser SG, Adams W

Published Online:

January 21, 2009

Central retinal artery occlusion occurs when the blood supply to the inner part of the retina (the light sensitive layer inside the eye) is suddenly stopped. If the blockage is removed in time, and the blood supply returns to the retina, full recovery is possible. However, if the blockage is prolonged the retina dies. Various methods have been tried in an attempt to remove the blockage including massaging the eye, lowering the pressure inside the eye and dissolving clots with drugs. Which of these methods is best for re-establishing the blood supply is not known and some of the treatments can be associated with serious adverse effects. This review did find two studies that suggested that the blood supply to the retina could be improved with the treatments they tested - although vision was not shown to be improved with either method in the study population. These were, however, small studies and did have potential flaws so more research is still needed.

Abstract (click to read)

Background:

Acute central retinal artery occlusion (CRAO) occurs as a sudden interruption of the blood supply to the retina and results in an almost complete loss of vision in the affected eye. There is no generally agreed treatment regimen although a number of therapeutic interventions have been proposed.

Objectives:

The objective of this review was to examine the effects of treatments used for acute non-arteritic CRAO.

Search strategy:

We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (which contains the Cochrane Eyes and Vision Group Trials Register) (The Cochrane Library, Issue 3, 2008), MEDLINE (January 1966 to September 2008), EMBASE (January 1980 to September 2008) and the reference lists of relevant papers.

Selection criteria:

We included randomised controlled trials (RCTs) only in which one treatment aimed to re-establish blood supply to the retina in people with acute CRAO was compared to another treatment.

Data collection and analysis:

Two authors independently assessed the search results for relevant trials. Discrepancies were resolved by discussion.

Main results:

We found two RCTs that met our inclusion criteria.

Authors' conclusions:

The included studies in this review were small and from single centres. Neither study was completely clear about it's method of treatment allocation. One study described the use of pentoxifylline tablets (three 600 mg tablets daily) and the other the use of enhanced external counterpulsation (EECP) combined with haemodilution. Both studies indicated improved retinal perfusion in the non-control group but neither showed an improvement in vision. Large, well-designed RCTs are still required to establish the most effective treatment for acute CRAO. These studies should be looking at factors important to the patient i.e. improved vision with acceptable risk/side-effects.

This record should be cited as:

Fraser SG, Adams W. Interventions for acute non-arteritic central retinal artery occlusion. Cochrane Database of Systematic Reviews 2009, Issue 1. Art. No.: CD001989. DOI: 10.1002/14651858.CD001989.pub2

Assessed as up to date:

September 16, 2008

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Primary Review Group:

Eyes and Vision Group

Health topics:

Eyes & vision > Retinal vascular occlusion

Cochrane Summaries^beta

Independent high-quality evidence for health care decision making

Treatments for acute central retinal artery occlusion (blockage of the blood supply to the retina of the eye)

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