Various Therapies for CRAO
The visual prognosis of CRAO remains poor despite treatment. There is no consensus available regarding the optimal treatment for CRAO. Time is crucial in management. Proposed therapies are aimed at restoring retinal perfusion or oxygenation
Various therapies have been tried with variable success:
Immediate ocular massage: Ocular massage may induce oscillations of intraocular pressure and dislodge the offending thrombus.
Drugs to reduce intraocular pressure: IV acetazolamide 500 mg, mannitol (1.5 to 2 g/kg over 30 to 60 min), and topical timolol (0.5%, 1 drop twice daily)
Anterior chamber paracentesis: Paracentesis is often recommended in conjunction with or after failed digital ocular massage. It is expected to cause sudden ocular hypotony and possible dilation of retinal arteries
Carbogen: A mixture of 95% oxygen and 5% carbon dioxide inhalation is thought to cause vasodilation and increased oxygen supply to the retina. Carbogen is given 10 minutes per 1 hour during waking and 10 minutes per 4 hours during sleep for 2 to 3 days
Hyperventilation into a paper bag: Respiratory acidosis and vasodilation are induced by either hyperventilation into a paper bag or by inhaling 10% carbon dioxide
Pentoxifylline: Works by increasing erythrocyte flexibility, reducing blood viscosity, and improving perfusion
Sublingual isosorbide dinitrate: 10 mg causes vasodilation
Supplemental oxygen
IV methylprednisolone
IV thrombolysis (fibrinolysis): IV infusion of alteplase, also known as tissue plasminogen activator, 0.9 mg/kg
Intra-arterial thrombolysis
Hyperbaric oxygen therapy: Aims to increase blood oxygen tension
Neodymium:yttrium-aluminum-garnet laser embolectomy
Pars plana vitrectomy: The procedure with a longitudinal incision over the artery or arteriole and thrombus removal has been reported in a few cases
Image from Rajan Eye Care Hospital
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