A 68-year-old hypertensive man presents with sudden painless loss of vision. Fundus shows disc edema, dilated tortuous veins in all quadrants, flame hemorrhages, and a cherry red spot at the fovea. The diagnosis is central retinal artery occlusion (CRAO). Which treatment has shown efficacy within the therapeutic window of 4.5 hours?
- A Anterior chamber paracentesis to reduce IOP
- B Intravitreal anti-VEGF injection
- C Systemic intravenous thrombolysis (tPA) ✓
- D Hyperbaric oxygen therapy
Explanation
Recent evidence (EAGLE study and subsequent data) supports intra-arterial or intravenous tPA administered within 4.5 hours of CRAO onset, based on analogy with cerebrovascular accident protocols given the shared pathophysiology (arterial thromboembolism). While no treatment is definitively proven to fully reverse CRAO, IV/IA tPA within this window has shown improvement in visual outcomes in some series. Anterior chamber paracentesis, ocular massage, and IOP reduction are traditional approaches without strong evidence. Intravitreal anti-VEGF treats secondary neovascularization but does not restore perfusion. Hyperbaric oxygen may slow retinal damage but evidence is limited.
Reference: Khurana Comprehensive Ophthalmology, 7th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.