AIM: The systemic acute thrombolysis (fibrinolysis) is one of methods how to treat occlusion of the central retinal artery. We present our first results of this rarely used treatment. MATERIAL AND METHODS: The patients were treated by means of i.v. infusion of the fibrinolytic alteplasis (plasminogen tissue activator, Actilyse) with the dose 0.9 mg/kg of body weight, first as a bolus of 10% of the dose, the rest was slowly applied while monitoring vital functions and coagulations parameters. The contraindications of the thrombolysis are especially tumors, bleeding, any surgery in last three months, and the brain stroke in the medical history, and diseases of the liver and kidneys. From November 2006 to April 2007, we treated 5 patients by means of thrombolysis; two patients with the occlusion of the temporal branch retinal artery (BRAO) with characteristic quadrant scotoma of the visual field and decrease of the visual acuity, and three patients with central retinal artery occlusion or hemi-occlusion (CRAO). RESULTS: The central visual acuity improved in all patients the next day after the thrombolysis. Both patients with the branch retinal artery occlusion had visual acuity 1.0, the delay between the thrombosis and the treatment was more than 12 hours. In two out of three patients with the central occlusion the visual acuity improved from practical blindness to 0.66. The third patient came with the latency of more than 30 hours; he registered partial improvement shortly after the thrombolysis, but later, the visual acuity decreased again. CONCLUSION: The thrombolytic treatment is definitely an advantage comparing to the conservative treatment. According to many contraindications and possible complications, it is necessary to select the eligible patient carefully. The treatment can be done on specialized in-patient department with the possibility to monitor vital functions and coagulations factors during the treatment as well as after it. In four out of five of our patients, the treatment finished with fast recovery of visual acuity almost to the normal.The effect of the treatment was good up to 18 hours after the occlusion; after 30 hours it was bad.

• MeSH
• fibrinolytika terapeutické užití   MeSH
• lidé středního věku MeSH
• lidé MeSH
• okluze retinální arterie farmakoterapie   MeSH
• senioři MeSH
• tkáňový aktivátor plazminogenu terapeutické užití   MeSH
• trombolytická terapie * MeSH
• trombóza farmakoterapie   MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• anglický abstrakt MeSH
• časopisecké články MeSH
• Názvy látek
• fibrinolytika MeSH
• tkáňový aktivátor plazminogenu MeSH

The authors present an account on possible aimed thrombolytic treatment of occlusion of the retinal artery by urokinase. Aimed thrombolysis can be performed at ophthalmological departments with an available radiodiagnostic department, which performs angiographies of carotid arteries. The authors discuss the necessary dose of 200,000 to 300,000 i.u. of urokinase. One-hour infusion with an initial booster dose is best. Early administration of the preparation is considered most important by the authors. The authors present the case-history of a 34-year-old patient with complete occlusion of the central retinal artery with haemodynamically severe aortal stenosis with a congenital background. Urokinase was administered six hours after occlusion of the artery. Gradually reperfusion of the retina occurred and improvement of the visual acuity from 0.01 to 0.17 with a residual relative wedge-shaped loss of the visual field and paleness of the disc of the optic nerve.

• MeSH
• aktivátor plazminogenu urokinázového typu terapeutické užití   MeSH
• dospělí MeSH
• lidé MeSH
• okluze retinální arterie farmakoterapie   MeSH
• trombolytická terapie * MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• mužské pohlaví MeSH
• Publikační typ
• anglický abstrakt MeSH
• časopisecké články MeSH
• kazuistiky MeSH
• Názvy látek
• aktivátor plazminogenu urokinázového typu MeSH

Cilioretinal artery occlusion is rare pathological condition because of infrequent occurrence of the cilioretinal artery in the human retina. It presents as an isolated entity, or as a combined cilioretinal artery--central retinal vascular, mostly venous occlusion. Authors present the course, angiographic features, prognosis, risk factors and final outcome of the isolated cilioretinal artery occlusion and combined cilioretinal artery--central retinal vein occlusion. Occlusion of the cilioretinal artery is believed to result from obstruction of the central retinal vein, as a primary process, in the case of combined cilioretinal artery--central retinal vein occlusion.

• MeSH
• arteria centralis retinae abnormality   patofyziologie   MeSH
• arteriální okluzní nemoci komplikace   diagnóza   patofyziologie   MeSH
• ciliární arterie abnormality   patofyziologie   MeSH
• dospělí MeSH
• fluoresceinová angiografie MeSH
• lidé středního věku MeSH
• lidé MeSH
• okluze retinální arterie komplikace   diagnóza   patofyziologie   MeSH
• okluze retinální žíly komplikace   diagnóza   patofyziologie   MeSH
• prognóza MeSH
• vena centralis retinae patofyziologie   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• Publikační typ
• anglický abstrakt MeSH
• časopisecké články MeSH
• kazuistiky MeSH

Rubeosis iridis is one of the severest complications of the occlusive diseases of retinal vessels associated with retinal hypoxia. In the pathogenesis of rubeosis, the author emphasizes the chronicity of retinal hypoxia which leads to the production of the vasoproliferative substance. This so-called vasoproliferative factor then induces the new formation of vessels on the retina, the optic disc, the iris and the anterior chamber angle. Neovascularization of the anterior chamber angle then very often results in the development of the prognostically very unfavourable neovascular glaucoma. It shows that the most effective methods of treatment of rubeosis iridis are the so-called coagulation techniques-panretinal photocoagulation or cryocoagulation. By application of these techniques, we achieve the destruction of the anatomical substrate which is responsible for the production of the vasoproliferative substance, and the result is involution of rubeosis on the iris and in the anterior chamber angle.

• MeSH
• fotokoagulace MeSH
• glaukom neovaskulární etiologie   patofyziologie   terapie   MeSH
• lidé MeSH
• nemoci duhovky etiologie   patofyziologie   terapie   MeSH
• nemoci retiny komplikace   patofyziologie   MeSH
• okluze retinální arterie komplikace   patofyziologie   MeSH
• okluze retinální žíly komplikace   patofyziologie   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH

Combined occlusion of central retinal vein and cilioretinal artery represents 40% of all cilioretinal artery occlusions. Pathogenesis of this uncommon occlusion remains controversial. We present three cases id combined vascular occlusion that were diagnosed at our department from 2003 until 2008. Our patients, all productive age, had undergone complete clinical examinations and investigations to determine the cause of this condition. One patient had been diagnosed to have heterozygous form of protrombine mutation. Curious is also possible connection of vascular occlusion and application of anti-Hepatitis A and B vaccine.

• MeSH
• fluoresceinová angiografie MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladý dospělý MeSH
• okluze retinální arterie komplikace   diagnóza   MeSH
• okluze retinální žíly komplikace   diagnóza   MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mladý dospělý MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• anglický abstrakt MeSH
• časopisecké články MeSH

An analysis of three women with retinal vaso-occlusive disease in systemic lupus erythematosus produced evidence for this most severe ophthalmic complication during the acute phase of the syndrome. Vaso-occlusive retinopathy appeared 5 years after the onset of systemic symptomatology in all of them. Association of central nervous system lupus and circulating anti-coagulants with increased occurrence of severe retinal vaso-occlusive disease are the subject of the present report. Unilateral extensive photocoagulation of two cases appeared to result in successful therapy of neovascular glaucoma after the central retinal artery occlusion in one patient. Lupus erythematosus is very serious systemic and ocular disease also in present time.

• MeSH
• dospělí MeSH
• lidé MeSH
• okluze retinální arterie diagnóza   etiologie   terapie   MeSH
• systémový lupus erythematodes komplikace   MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• anglický abstrakt MeSH
• časopisecké články MeSH
• kazuistiky MeSH

PURPOSE: Describe the clinical finding and course of treatment in patients with a sudden decrease in visual function due to an acute occlusion of the arteria centralis retinae. Patients were primarily indicated for selective angiography with thrombolysis of the ophthalmic artery. MATERIALS AND METHODS: Medical documentation of two patients with acute central retinal artery occlusion with a time duration of up to 5 hours was evaluated retrospectively. The diagnosis of central retinal artery occlusion was determined on the basis of a detailed ophthalmological examination in arteficial mydriasis. The initial best-corrected visual acuity (BCVA) were hand movement in front of the eye with uncertain light projection in first patient and no light perception in the second patient. In both cases a relative afferent pupillary defect of the 4th degree was present with the onset of the ischemic macular edema and an incipient development of the cherry red spot. After evaluation of the overall condition, laboratory findings, exclusion of cancer and surgery in the last three months, a selective angiography of ophthalmic artery and thrombolysis in collaboration with the intervention radiologist were performed. Results: First patient with a better initial visual acuity, selective angiography demonstrated a decrease in flow in the central retinal artery with subsequent improvement in haemodynamic ratios after application of 12 ml of recombinant tissue plasminogen activator (Alteplase). The BCVA improved to 1/ 60 after interventional procedure. We did not experience any serious treatment side effects during or after intervention. In the second patient, selective angiography of the intracranial arteries and internal carotids revealed the presence of an aneurysm before the ophthalmic artery. Due to the normal flow of the contralateral carotid and the filling of the intracranial vessels on the affected side via the circle of Willis, the internal carotid ligation was performed under the aneurysm. Three months after the surgery BCVA was no light perception and patient had no neurological symptomatology. CONCLUSION: Selective angiography in combination with thrombolysis appears to be a useful imaging as well as therapeutic method for acute central retinal artery occlusion. This technique allows not only to confirm the diagnosis but it can also solve problem causally and improve the visual acuity of the affected person. Sometimes it also helps to clear the cause of the closure and prevent next potential embolization into the intracranial space and possible fatal consequences of CNS involvement or even death.

• Klíčová slova
• CRAO, Selective angiography, aneurysm of the internal carotid artery, central retinal artery occlusion, recombinant tissue plasminogen activator, thrombolysis,
• MeSH
• angiografie * MeSH
• lidé MeSH
• okluze retinální arterie * diagnostické zobrazování   farmakoterapie   MeSH
• retrospektivní studie MeSH
• tkáňový aktivátor plazminogenu * MeSH
• trombolytická terapie MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• Názvy látek
• tkáňový aktivátor plazminogenu * MeSH

• MeSH
• amaurosis fugax diagnostické zobrazování   etiologie   MeSH
• embolie * MeSH
• lidé MeSH
• okluze retinální arterie * komplikace   diagnostické zobrazování   MeSH
• slepota MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

PURPOSE: Ischemic edema of the retina develops after CRAO and a regressive phase follows usually without any possibility of objectification. The aim of the study is to determine dynamics of edematous changes in the central retina using the OCT (Optical Coherence Tomography). SETTING: Department of Ophthalmology, Regional Hospital in Pardubice, Czech Republic, E.U. METHODS: During the period between June 2004 and January 2005, ten patients with the diagnosis of CRAO were examined by means of Stratus OCT3 (Zeiss). A protocol designed for analysis of the thickness and volume of the macula (Fast Macular Thickness Map) was used for the evaluation. Obtained readings were compared with the healthy eye. Examinations were performed on the 1st up to the 5th day after the CRAO onset and 2, 5, and 10 weeks thereafter. RESULTS: The average volume of the macula (Average Total Macula Volume) of the affected eye was (mean +/- SD; mm3): at the day of diagnosis (the initial examination) 9.196 +/- 1.376 (range, 10.315-7.301), the 2nd week 7.313 +/- 1.209 (range, 9.441-5.854), the 5th week 5.970 +/- 0.688 (range, 7.401-4.971), and the 10th week 5.091 +/- 0.558 (range, 5.768-3.989). The average volume of the most swollen macular quadrate was (mean +/- SD; mm3): at the day of diagnosis (the initial examination) 0.695 +/- 0.319 (range, 1.526-0.359), the 2nd week 0.607 +/- 0.206 (range, 1.118-0.416), the 5th week 0.520 +/- 0.220 (range, 1.070-0.334), and the 10th week 0.409 +/- 0.195 (range 0.948-0.282). In some patients, the onset of macular atrophy was found 5 weeks after the CRAO. No edema in the macular area was confirmed in any patient 10 weeks after the CRAO. CONCLUSION: On the average, we proved the regression phase of the retinal edema 5 weeks after the CRAO appearance. The OCT examination appears to be a suitable method for the determination of the dynamics of the edematous changes in the macular area after the CRAO.

• MeSH
• akutní nemoc MeSH
• lidé středního věku MeSH
• lidé MeSH
• okluze retinální arterie diagnóza   patologie   MeSH
• optická koherentní tomografie * MeSH
• senioři MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• anglický abstrakt MeSH
• časopisecké články MeSH

Central retinal artery occlusion (CRAO) is a form of acute ischemic stroke. It is a critical condition that often leads to severe visual loss or blindness and can be a harbinger of further cerebrovascular events. Due to the lack of scientific data, there are no effective evidence-based forms of therapy for this condition. None of the conservative therapies have proven effective. The results of some previously published studies suggest a benefit of intravenous thrombolytic therapy in the same regimen as in the treatment of ischemic stroke. This work aims to present an overview of published clinical studies focused on the use of intravenous thrombolysis for CRAO, evaluate its efficacy and safety, and propose an optimal diagnostic and therapeutic algorithm for acute management of CRAO. Summary statistics of patient data from relevant studies indicate that a significant visual acuity improvement was achieved by a total of 45 % of patients receiving alteplase within 4.5 hours of symptoms onset. The occurrence of adverse events in this time window was not significant. Intravenous thrombolytic therapy in CRAO thus appears to be effective and safe. However, we still lack data from adequate prospective randomized controlled trials to confirm this conclusion. To date, two randomized trials are being conducted. The intravenous thrombolysis administration, patient monitoring, etiologic workup, and setting of effective secondary prevention should be ensured at the centre of highly specialized cerebrovascular care. Urgent transport of the CRAO patient to the nearest centre is essential.

• Klíčová slova
• Visual acuity, alteplase, central retinal artery occlusion, thrombolysis,
• MeSH
• cévní mozková příhoda * komplikace   farmakoterapie   MeSH
• ischemie mozku * MeSH
• lidé MeSH
• okluze retinální arterie * farmakoterapie   MeSH
• prospektivní studie MeSH
• trombolytická terapie MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH