A telemedicine-enabled intravenous thrombolytic treatment pathway for patients with hyperacute non-arteritic central retinal artery occlusion.

Autor:	Gilbert AL; Kaiser Permanente Northern California, Department of Ophthalmology, Vallejo, CA, USA., Patel AP; Kaiser Permanente Northern California, Department of Ophthalmology, Oakland, CA, USA., Sax D; Kaiser Permanente Northern California, Department of Emergency Medicine, Oakland, CA, USA., Bhatti MT; Kaiser Permanente Northern California, Department of Ophthalmology, Roseville, CA, USA., Shah R; Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA., Dokey A; Kaiser Permanente Northern California, Department of Ophthalmology, Oakland, CA, USA., Mannis T; Kaiser Permanente Northern California, Department of Ophthalmology, Oakland, CA, USA., Burnett M; Kaiser Permanente Northern California, Department of Neurology, Oakland, CA, USA., Vora RA; Kaiser Permanente Northern California, Department of Ophthalmology, Oakland, CA, USA.
Jazyk:	angličtina
Zdroj:	American journal of ophthalmology case reports [Am J Ophthalmol Case Rep] 2024 Oct 20; Vol. 36, pp. 102204. Date of Electronic Publication: 2024 Oct 20 (Print Publication: 2024).
DOI:	10.1016/j.ajoc.2024.102204
Abstrakt:	Purpose: To describe the visual acuity (VA) outcomes from a telemedicine-enabled pathway allowing for rapid diagnosis and administration of intravenous (IV) thrombolytic treatment for non-arteritic central retinal artery occlusion (naCRAO) within 4.5 hours (4.5 h) of visual loss. Design: Retrospective observational case series. Methods: Setting: A large managed healthcare consortium.Patient Population: Eighty-five patients with naCRAO and vision loss for less than 4.5 h presenting between 2021 and 2023. Thirty-five patients received IV thrombolytic therapy and 50 patients were closely observed.Intervention: A collaborative telemedicine-enabled pathway employing fundus photography was previously established by Ophthalmology, Emergency Medicine, and Stroke services to rapidly evaluate and manage patients presenting with acute painless monocular vision loss and allow for administration of IV tenecteplase (0.25 mg/kg) for eligible consenting patients diagnosed with naCRAO within 4.5 h. Retrospective chart review was conducted to collect data on demographics, vascular risk factors, clinical features, VA outcomes, and adverse events. Comparison was made between patients who received intravenous thrombolysis and those who were observed.Main Outcome Measures: Improvement in VA of at least 0.3 logarithm of the minimum angle of resolution (logMAR) and/or from 20/200 or worse to 20/100 or better. Results: A greater percentage of patients in the treated group had VA improvement of ≥0.3 logMAR (54.3 % vs 28 %, p = .014), and a greater percentage of patients in the untreated group had VA worsening of ≥0.3 logMAR (30 % vs 5.7 %, p = .006). Twice the percentage of treated versus untreated patients had improved VA from 20/200 or worse to 20/100 or better, but this difference was not statistically significant (20 % vs 10 %, p = .192). There was a significantly shorter mean time to treatment for those patients who had VA improvement from 20/200 or worse to 20/100 or better compared to those who did not (118 versus 171 min, p = .031). Two patients experienced intracranial bleeding after IV thrombolysis. Conclusions: The evaluation and treatment of hyperacute naCRAO is possible on a large scale via an integrated telemedicine-enabled approach utilizing fundus photography. The use of IV thrombolytic was associated with better VA outcomes compared to observation alone. Prospective randomized controlled trials are needed to confirm these findings and determine optimal management. Competing Interests: Aubrey L. Gilbert (No disclosures to report). Amar P. Patel (No disclosures to report). Dana Sax (No disclosures to report). M. Tariq Bhatti (Bristol Meyers Squibb, Consultant). Ronak Shah (No disclosures to report). Adrian Dokey (No disclosures to report). Tova Mannis (No disclosures to report). Molly Burnett (No disclosures to report). Robin A. Vora (Iveric Bio, Speaker; Outlook Therapeutics, Consultant, Advisory Board; Paradigm Pharmaceuticals, Consultant; Regeneron, Advisory Board; Genentech, Advisory Board; EyePoint Pharmaceuticals, Consultant). (© 2024 The Authors.)
Databáze:	MEDLINE
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