11 Aug Traditional Treatments For Central Retinal Artery Occlusion May Be Worse Than No Treatment
MedicalResearch.com Interview with:
Matthew Schrag MD
Department of Neurology
Yale University
New Haven, Connecticut
Medical Research: What is the background for this study? What are the main findings?
Dr. Schrag: Central retinal artery occlusion (CRAO) is a relatively rare disorder that is caused by interruption of blood flow to the retina, usually by a clot or some other embolus. Despite around 150 years of research, no compelling treatment has been found for this disease. Treatment with fibrinolytics has been used experimentally for a long time and some of the results have been encouraging. The point of the current study was to aggregate all of this observational data and compare how patients withCentral retinal artery occlusion do when treated with fibrinolytics versus when they are treated with other approaches or not treated at all.
The biggest surprise in the data was the poor performance of conventional treatments at less than half the recovery rate of patients who were simply left alone. The literature on treating central retinal artery occlusion with ocular massage, hemodilution or anterior chamber paracentesis has never been particularly compelling, but these treatments were thought to be harmless and are often practiced in the acute management of central retinal artery occlusion. This new analysis strongly suggests that these interventions may be harmful. While this data is not perfect (it is retrospective, non-randomized, acquired over long periods of time, etc), for me it raises enough doubt that I think ocular massage, anterior chamber paracentesis and hemodilution should be abandoned as treatments for acute CRAO.
Medical Research: What should clinicians and patients take away from your report?
Dr. Schrag: The data is encouraging regarding the effectiveness of tPA for CRAO — but only early on. This is not strong enough data to make a compelling recommendation that patients with CRAO should receive tPA. However, many centers do treat CRAO off-label with tPA and for those centers I would recommend only treating within the first 4.5 hours.
Medical Research: What recommendations do you have for future research as a result of this study?
Dr. Schrag: This type of analysis tries to maximize the power of observational data. Rare diseases like CRAO are hard to study in randomized controlled trials which give us the best quality data. Maximizing the usefulness of retrospective and observational data can help to ensure the best possible clinical design and I hope will improve the odds of having a successful trial.
Citation:
[wysija_form id=”5″]
MedicalResearch.com is not a forum for the exchange of personal medical information, advice or the promotion of self-destructive behavior (e.g., eating disorders, suicide). While you may freely discuss your troubles, you should not look to the Website for information or advice on such topics. Instead, we recommend that you talk in person with a trusted medical professional.
The information on MedicalResearch.com is provided for educational purposes only, and is in no way intended to diagnose, cure, or treat any medical or other condition. Always seek the advice of your physician or other qualified health and ask your doctor any questions you may have regarding a medical condition. In addition to all other limitations and disclaimers in this agreement, service provider and its third party providers disclaim any liability or loss in connection with the content provided on this website.
Matthew Schrag MD (2015). Traditional Treatments For Central Retinal Artery Occlusion May Be Worse Than No Treatment
Last Updated on August 11, 2015 by Marie Benz MD FAAD