A meta-analysis identified 16 studies, all of which were retrospective and non-randomised 1. After correction for data duplication, the results of 100 patients can be reported. A final acuity of 6/6 or better was seen in 14% of patients following local intra-arterial fibrinolysis, and a visual result of 6/12 or better was seen in 27% of subjects. A poor final acuity of 3/60 or worse was seen in 60.6% of eyes treated with local intra-arterial fibrinolysis (LIF). These results compare favourably with conventional forms of therapy. Potentially serious complications were seen in four patients, but no patient suffered a permanent neurological deficit. Conclusion of the authors: There may be a marginal visual benefit associated with LIF compared with conventional management However, the methodology of the cited studies was often unsatisfactory. Outside of a randomised clinical trial, the use of superselective fibrinolytic therapy for central retinal artery occlusion cannot be recommended on the basis of current evidence.
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