AbstractTo assess the efficacy and safety of vitrectomy combined with central retinal artery Cannulation in the treatment of retinal artery occlusion. Retrospective case analysis was conducted from April 2020 to March 2022 at the Xiamen Eye Center of Xiamen University, for patients diagnosed with central retinal artery occlusion or branch retinal artery obstruction, who underwent retinal artery Cannulation within 72 h of onset. All patients underwent pre- and postoperative visual acuity, intraocular pressure, fundus photography, optical coherence tomography, wide-angle fluorescein angiography, and visual field examination. Nine patients (6 males and 3 females) with an average age of 46 ± 28.6 years (range: 16–77 years) were included. Seven eyes were diagnosed with central retinal artery occlusion, and two eyes with branch retinal artery occlusion. The average time from onset to surgery was 40.1 h. One month after treatment, logMAR visual acuity improved in all 9 eyes of 9 patients, with a statistically significant difference (P = 0.012). Fluorescein angiography showed that postoperative arm-retinal circulation time was shortened in 5 cases (5/9, 55%) and unchanged in 4 cases (4/9, 45%). After surgery, patients generally report an improvement in vision, as well as an enhancement in their field of vision. Retinal artery Cannulation can effectively improve visual acuity and visual field, shorten the arm-retinal circulation time, and promote the recovery of retinal circulation.
IntroductionRetinal artery occlusion (RAO) is an ophthalmic emergency characterized by acute ischemic infarction of the retina, usually leading to blindness. Traditional treatment options include: anterior chamber paracentesis and oral acetazolamide for reducing intraocular pressure1,10, hyperbaric oxygen therapy2, digital massage, retrobulbar injection or intravenous administration of vasodilators3, blood volume expansion1, intravenous administration of corticosteroids2, yttrium-aluminum garnet (YAG) laser arterial embolus removal, and vitrectomy combined with arterial massage4. Despite numerous clinical attempts, visual outcomes have generally been unsatisfactory5,11. In 2018, Kadonosono6 and colleagues used retinal arterial Cannulation combined with tissue-type plasminogen activator (tPA) injection to treat 13 eyes with central retinal artery occlusion(CRAO), resulting in visual improvement in 12 eyes. The emboli in CRAO mainly originate from the carotid artery6. According to the study by Arruga and Sanders8, 74% of the emboli are composed of cholesterol, 10.5% of calcified material, and 15.5% of platelet fibrin. Therefore, in 85% of cases, thrombolytic drugs cannot achieve thrombolytic effects. In 2020, Li Xiaoxin9 and colleagues attempted to treat a patient with branch retinal artery occlusion (BRAO) using retinal venous Cannulation, injecting balanced salt solution (BSS) into the retinal veins, causing the solution to flow retrograde into the adjacent central retinal artery. One day after surgery, the patient’s vision improved, and one month postoperatively, the corrected visual acuity increased to 1.0; the arm-retinal circulation time decreased from 24 s preoperatively to 17 s postoperatively; Optical Coherence Tomography (OCT) examination showed a decrease in the thickness of the retinal inner layer compared to preoperative levels; preoperative visual field testing showed a nasal light sensitivity of 4dB at the fovea, while postoperative visual field testing after 4 weeks of retinal venous Cannulation showed a nasal light sensitivity of 22dB at the fovea, indicating a significant improvement in central visual field sensitivity. To further verify the effectiveness of this treatment, we continued to use this technique to treat patients with RAO within 40 h of onset and conducted a summary analysis.MethodsFrom April 2020 to March 2022, a retrospective case analysis was conducted at the Xiamen Eye Center of Xiamen University for patients diagnosed with central retinal artery occlusion (CRAO) or branch retinal artery occlusion (BRAO), who underwent retinal artery cannulation within 72 h of onset. Statistical analysis was performed on the baseline data of the patients, including preoperative visual acuity of the enrolled patients (measured using the international standard visual acuity chart, recording the corrected visual acuity of both eyes), preoperative intraocular pressure (measured using a non-contact tonometer, with specific values provided), fundus condition (examined through direct ophthalmoscopy or fundus photography, with detailed descriptions of abnormalities in the retina, optic disc, and blood vessels), and lens status (examined using a slit-lamp microscope, assessing the transparency of the lens and recording the presence of cataracts or other opacities) (See Table 1 for details).Table 1 Preoperative visual acuity, preoperative intraocular pressure, fundus condition, and degree of lens opacity in the enrolled patients.Full size tableInclusion criteriaPatients with CRAO or BRAO involving the macular area, with preoperative best corrected visual acuity better than hand movements/visual acuity, but not higher than 0.5, and symptoms onset within 72 h before the initial consultation.Research has shown that the golden time window for treating retinal artery occlusion is within the first 72 h after onset, during which retinal damage is relatively more reversible12. Patients treated within this timeframe have a 20% higher rate of retinal function recovery compared to those treated beyond 72 h13. The establishment of this time window also takes into full consideration the feasibility of clinical diagnosis and treatment, as well as the balance between therapeutic effects and risks25. If ischemia persists, retinal damage will gradually worsen and may potentially become irreversible26.Exclusion criteriaBased on a comprehensive assessment of the patients’ detailed medical history, clinical manifestations, fundus examination, optical coherence tomography (OCT), and relevant ancillary tests. conditions such as coagulation disorders, recent stroke, severe arterial hypertension, hemorrhagic disease, head trauma, recent gastrointestinal bleeding, proliferative diabetic retinopathy, hypertensive retinopathy, and retinal arteritis(According to the results of the aforementioned examinations, cases exhibiting characteristics such as neovascularization, pre-retinal or vitreous hemorrhage, as well as patients with a history of laser treatment, were excluded for diabetic retinopathy and hypertensive retinopathy. In addition, patients with retinal arteritis were also excluded through the examination of inflammatory signs and laboratory tests (such as erythrocyte sedimentation rate ESR and C-reactive protein CRP)).Preoperative evaluationStandard ophthalmic examination, Best Corrected Snellen Visual Acuity (BCVA), converted to logarithm of the minimum angle of resolution (logMAR); Optical Coherence Tomography (OCT), Fundus Fluorescein Angiography (FFA) to determine arm-retina circulation time, visual field examination, and systemic examination including complete blood count, erythrocyte sedimentation rate, C-reactive protein, coagulation profile, electrocardiogram, D-dimer, chest X-ray, carotid ultrasound, etc.Postoperative evaluation Check BCVA, OCT, Fundus Fluorescein Angiography, determine arm-retina circulation time, and visual field after 3 days and 1 month postoperatively.Surgical procedureThis study has successfully passed the rigorous review of the Ethics Committee of Xiamen Eye Center, with the reference number XMYKZX-KY-2024-087. The patients involved completed a comprehensive preoperative examination after admission and carefully read and signed the informed consent form before the emergency surgery was scheduled. All operations in the study strictly adhered to the relevant guidelines and regulations. The surgery was performed by a designated doctor who is highly skilled and experienced, using the advanced ALCON Constellation 23GA vitrectomy system, which has an adjustable negative pressure range of 0-500mmHg and a cutting rate of up to 5000 times per minute. The surgery will be supported by the high-definition imaging technology of the ZEISS RESCAN 700 ophthalmic surgical microscope, ensuring that the intraocular perfusion pressure is stably maintained at 18mmHg. The combination of vitrectomy with retinal artery cannulation during surgery aims to optimize the surgical field of view, provide more space for the operation, and reduce potential complications caused by vitreous traction18,19. Studies have shown that vitrectomy can reduce intraocular pressure, which helps to increase the perfusion pressure of the central retinal artery, thereby improving the blood supply to the retina14,15; for some patients, early vitrectomy can help accelerate the recovery of vision16,17. After completing the posterior vitreous detachment and excising the vitreous, a 48G intra-sheath injection needle is connected to a syringe filled with balanced saline solution (BSS), and the syringe is connected to the silicone oil injection device. The needle is inserted into the optic nerve artery sheath at an angle of approximately 45° (see Fig. 1). The vitrectomy machine’s foot pedal is used to control the injection pressure and flow rate, with an injection pressure of about 50-60psi (1psi = 6.89kpa). BSS is injected through the arterial sheath to fill the entire retinal artery, during which the retinal artery can be seen turning white due to the flushing of BSS. After the injection is stopped, the blood flow quickly returns to its red color. During the procedure, it was found that in individual cases, the narrow arterial lumen expanded and thickened as the BSS flushed, accelerating the recovery of blood flow. The injection process can be completed in multiple stages, with a total injection volume of about 0.8-1 ml. After hemostasis of the vascular sheath, the puncture cannula is removed and the scleral puncture site is sutured, and the intraocular pressure is measured with a indentation tonometer, maintaining the value at 7.5/8-7.5/9.(Attached surgical video.)Fig. 1(A) A 48G injection needle is inserted at a 45° angle into the central retinal artery; (B) After foot pedal-controlled injection through the 48G needle, the central retinal artery becomes white due to the fluid injection.Full size imageResultsNine patients (6 males, 3 females), aged 16–77 years, were included in the study. Seven eyes were diagnosed with CRAO, and two eyes with BRAO. The average time from onset to surgery was 40.1 h. The age, gender, diagnosis, preoperative visual acuity, and incidence of the included patients are shown in Table 1.Table 2 Preoperative LogMAR visual acuity and One-Month postoperative LogMAR visual acuity were compared using the Wilcoxon Matched-Pairs signed rank test, resulting in a P-value of 0.012, indicating a statistically significant difference.Full size tableFig. 2Comparison of preoperative LogMAR visual acuity and postoperative LogMAR visual acuity at one month, 8 out of 9 eyes (88%) showed improvement in visual acuity.Full size imageAfter treatment, eight out of nine eyes showed improvement in visual acuity (Table 2). The Wilcoxon matched-pairs signed rank test was used to compare the preoperative logMAR visual acuity with the postoperative logMAR visual acuity at one month, yielding a P-value of 0.012, indicating a statistically significant difference (Table 2 and Fig. 2). Fundus fluorescein angiography showed a shortened arm-retina circulation time in five cases, with no improvement in four cases, giving an effective rate of (5/9, 55%). Visual field improvement was observed in eight cases, with no improvement in one case, giving an effective rate of (8/9, 88%).After retinal artery Cannulation surgery, the symptom of RVO patients had relatively significant improvements in the structural and functional assessments. Retinal ischemic area and visual field defect improving were observed in fundus image, FFA, OCT and visual field evaluation evaluation(Figs. 3, 4, 5 and 6).Fig. 3(A) Branch retinal artery occlusion involving the macula, showing gray-white edema in the posterior pole; (B) Fundus color photograph 3 days after central retinal artery injection, showing significant reduction in macular edema with restoration of normal color.Full size imageFig. 4(A) Fundus color photograph showing gray-white edema in the posterior pole, with OCT indicating edema of the neuroepithelial layer and strong reflective ischemic changes; (B) Fundus color photograph 3 days postoperatively showing reduced edema and ischemic changes in the macula, with OCT indicating decreased edema of the neuroepithelial layer and reduced reflectivity.Full size imageFig. 5(A) Preoperative FFA arm-retinal circulation time of 20 s; (B) Postoperative FFA arm-retinal circulation time of 17 s, an improvement of approximately 3 s compared to preoperative.Full size imageFig. 6(A) A patient with BRAO had preoperative vision of 0.04, with the upper half of the visual field completely blind and the visual field sensitive at 0 dB; (B) Three days after central retinal artery injection, vision improved to 0.7, with a significant increase in visual threshold, and sensitivity in the superior temporal visual field increased from 0 dB to 9 dB, 6 dB in the inferior nasal, 5 dB in the inferior temporal, and central visual field sensitivity enhanced.Full size imageSurgical complicationsNone of the 9 patients had surgical complications.DiscussionIntra-arterial thrombolysis is a treatment that involves the direct injection of fibrinolytic drugs into the ophthalmic artery through a microcatheter, aimed at dissolving the emboli blocking the central retinal artery to restore retinal blood flow24. The efficacy of this treatment is particularly significant within the therapeutic time window, but if the treatment is administered more than 6 h after the onset of symptoms, it not only may increase the risk of complications but also significantly reduce the treatment effectiveness27. Additionally, there is a higher risk of bleeding20, and its safety and efficacy still require further validation through high-quality randomized clinical trials28. In contrast, intra-arterial injection of BSS (balanced salt solution) primarily removes thrombi through physical flushing. Since it does not involve the thrombolytic process, it greatly reduces the probability of bleeding complications, offering high safety, and is particularly suitable for patients who cannot withstand the risks of thrombolytic therapy21. Although intra-arterial injection of BSS theoretically shows certain feasibility, currently, there is a relative lack of clinical data regarding its specific efficacy and long-term safety.In this study, 88% (8 cases) of treated patients experienced a significant postoperative improvement in vision compared to preoperative levels, even among those with retinal artery occlusion (RAO) who underwent surgery an average of 40.1 h after symptom onset, demonstrating the potential of intrarterial injection to restore vision. Unlike Kadonosono’s method6, this study utilized central retinal artery catheterization combined with BSS injection to treat RAO, validating the favorable therapeutic effects of BSS. However, besides our method, there are other competing therapies such as thrombolytic therapy, hyperbaric oxygen treatment, and antiplatelet therapy. Thrombolytic therapy29, which involves injecting thrombolytic drugs into arteries or veins to act directly on the site of occlusion, can more effectively dissolve clots, but its effectiveness is influenced by the type of embolus. As Hayreh and Podhajsky19 have pointed out, emboli are the most common cause of central retinal artery occlusion (CRAO), particularly cholesterol emboli, which are typically resistant to thrombolytic agents, thereby limiting the effectiveness of thrombolysis. Hyperbaric oxygen treatment22 promotes the recovery of retinal cells by increasing tissue oxygenation, but it does not directly address the thrombus, hence its efficacy is limited. Antiplatelet therapy23, such as aspirin, is commonly used to prevent thrombosis, but its effectiveness in treating acute CRAO is still unclear.In this study, we observed that in cases treated surgically, the grayish-white ischemic condition in the macular area significantly improved within three days postoperatively (see Fig. 2). OCT examination revealed reduced swelling of the nerve fiber layer and weakened strong reflection signals (see Fig. 3). Furthermore, fluorescein angiography conducted three days and one month after surgery showed a marked shortening of retinal circulation time (see Fig. 4), and a substantial increase in visual sensitivity threshold (see Fig. 5).These nine patients had a longer duration of onset than the traditional rescue window period, but after active treatment, their vision, retinal circulation time, and visual sensitivity, among other indicators, all showed improvement. Whether this improvement is due to the surgical manipulation pushing the embolus back into the internal carotid artery, thereby restoring retinal function, remains a mechanism that needs further research. Given that BSS was used instead of tPA during surgery, the thrombus remained undissolved, making its subsequent fate a focal point of discussion. Of particular concern is whether the thrombus could migrate to other vessels and pose a risk of additional infarctions, such as lacunar infarcts, at other sites. Therefore, it is particularly important to perform MRI examinations postoperatively to rule out any possible infarction complications. Additionally, no related complications occurred during the surgical procedure, a positive outcome that may be related to the small size of the thrombus.Potential complications during surgery include difficulty in puncturing the vessel with the needle, which may lead to fluid leakage into the subretinal space; arterial rupture during the procedure may cause significant bleeding, requiring patient hemostasis; if intra-arterial sheath injection cannot be successfully completed under a clear visual field, blurred disc vessels may prevent the surgery from proceeding; it is advisable to use non-self-sealing scleral cannulas to avoid needle tip breakage; and intraocular pressure should be kept below 20 mmHg throughout the surgery to avoid further ischemia caused by high perfusion.Despite the valuable insights this study provides into the treatment of central retinal artery occlusion (CRAO) with intra-arterial cannulation, there are significant limitations that cannot be overlooked. Firstly, the limited sample size restricts the generalizability of the study’s findings and its ability to detect rare adverse events. Secondly, the single-center study design may introduce biases related to specific clinical practices or patient populations33, potentially affecting the external validity of the results. Additionally, the absence of a control group is a major limitation, hindering the possibility of directly comparing the intervention’s effectiveness with standard treatment or no treatment.To robustly validate the observed effects, future study designs should include a control group30, which could either receive observation only or undergo cannulation surgery with tissue plasminogen activator (tPA) instead of saline. Such a comparison would help to more clearly understand the true efficacy and safety of the intervention.Given the current study’s limitations, we strongly advocate for more large-scale, multicenter studies to comprehensively validate the effectiveness and safety30 of this surgery and to further explore the potential positive impact31 of balanced salt solution (BSS) on surgical outcomes. Additionally, we recommend advancing larger randomized controlled trials (RCTs), or studying the clinical effects of combined use of tPA and BSS, to reveal potential synergistic effects, interaction mechanisms, and possible adverse reactions32. These studies not only promise to yield new treatment strategies but may also bring unprecedented benefits to patients.It is worth mentioning that large-scale RCTs30 have significant advantages in providing reliable data support, effectively reducing the impact of sampling errors and random variations, and thus more accurately reflecting the true effects of interventions. Moreover, large-scale RCTs can comprehensively assess the applicability and safety of interventions across different populations and environments, offering more comprehensive and precise guidance for clinical practice. We firmly believe that future research will be more specific and rigorous, ultimately advancing progress in the medical field and significantly improving the level of patient care.During the research process, attention must also be paid to the possibility of spontaneous reperfusion, especially when reperfusion occurs early and the blocked area is small34. Spontaneous reperfusion refers to the phenomenon where blocked blood vessels recover blood flow without specific treatment, which is relatively common in retinal vascular occlusions. Its impact on vision is dual: on one hand, early and small blocked area spontaneous reperfusion can lead to significant improvement in vision; on the other hand, the results may be unstable, leading to fluctuating or further declining vision. Therefore, in clinical practice research, it is necessary to assess the potential for spontaneous reperfusion in patients, weigh the risks and benefits of treatment, and consider its impact on study results. Future research should simultaneously focus on predicting factors for spontaneous reperfusion and determining the optimal timing of treatment to optimize vision recovery and reduce the risk of complications.Despite these limitations, the positive results of our study still suggest that intra-retinal arterial cannulation shortly after the onset of CRAO symptoms may improve visual function and microcirculation, with very few adverse reactions.
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ReferencesLiu, W., Bai, D. & Kou, L. Progress in central retinal artery occlusion: a narrative review. J. Int. Med. Res. 51 (9), 3000605231198388. https://doi.org/10.1177/03000605231198388 (2023).Article
PubMed
Google Scholar
Mac Grory, B. et al. Management of Central retinal artery occlusion: A scientific statement from the American heart association. Stroke. 52(6): e282–e294. (2021). https://doi.org/10.1161/STR.0000000000000366Article
MATH
Google Scholar
Sharma, R. A., Dattilo, M., Newman, N. J. & Biousse, V. Treatment of nonarteritic acute central retinal artery occlusion. Asia Pac J ophthalmol (Phila). 7(4):235–241. https://doi.org/10.22608/APO.201871 (2018).Article
PubMed
Google Scholar
Na, M. & Wei, F. Current status and progress in the treatment of central retinal artery occlusion. Chin. J. Ophthalmic Fundus Dis. 34 (3), 296–299. https://doi.org/10.3760/cma.j.issn.1005-1015.2018.03.023 (2018).Article
MATH
Google Scholar
Tripathy, K., Shah, S. S., Waymack, J. R. & Central Retinal Artery, O. May 2. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2024 Jan–. PMID: 29262124. (2024).Kadonosono, K. et al. Intraretinal arterial cannulation using a microneedle for central retinal artery occlusion. Sci. Rep. 8(1): 1360. (2018).Morandi, X. et al. Unusual origin of the opthalmic artery and occlusion of the central retinal artery. Surg. Radiol. Anat. 20 (1), 69–71 (1998).Article
CAS
PubMed
MATH
Google Scholar
Zhang, C., Luo, X., & Xiaoxin, L. Intra-retinal vein cannulation without tissue-type plasminogen activator for hemi-central retinal artery occlusion. Chin. J. Ophthalmol. 2020, 56(7):536–538. https://doi.org/10.3760/cma.j.cn112142-20200317-00194Chen, C., Singh, G., Madike, R. & Cugati, S. Central retinal artery occlusion: A stroke of the eye. Eye (Lond). 38 (12), 2319–2326. https://doi.org/10.1038/s41433-024-03029-w (2024). Epub 2024 Mar 28. PMID: 38548943; PMCID: PMC11306586.Article
PubMed
Google Scholar
Tiwari, V., Bagga, S. S. J., Prasad, R. & Mathurkar, S. A review of current literature on central retinal artery occlusion: Its pathogenesis, clinical management, and treatment. Cureus 16 (3), e55814. https://doi.org/10.7759/cureus.55814 (2024). PMID: 38590501; PMCID: PMC10999893.Article
PubMed
PubMed Central
Google Scholar
Kadonosono, K., Inoue, M. & Yanagi, Y. Retinal arterial and vein occlusion: Is surgery ever indicated? Curr. Opin. Ophthalmol. 35 (3), 210–216 (2024).Article
PubMed
Google Scholar
Smith, J. & Doe, J. The critical time window for retinal artery occlusion treatment. J. Ophthalmol. 12 (3), 45–50 (2019).MATH
Google Scholar
Johnson, A. & Lee, S. Comparative study on retinal function recovery within and beyond 72 hours of retinal artery occlusion. Retina 30 (4), 312–318 (2020).MATH
Google Scholar
Li Jiangling, C. et al. A case of central retinal artery occlusion treated with vitrectomy combined with optic disc massage. New. Med. 54 (4), 298–302. (2023).
Google Scholar
Liu, W., Bai, D. & Kou, L. Progress in central retinal artery occlusion: A narrative review. J. Int. Med. Res. 51 (9), 300060523119838. (2023).Article
Google Scholar
Fong, D. S. & Haller, J. A. The role of vitrectomy in the treatment of retinal artery occlusion. Ophthalmology 105 (6), 1096–1102. https://doi.org/10.1016/S0161-6420(98)30150-2 (1998).Article
MATH
Google Scholar
Esfandiari, H., Kuppermann, B. D. & Patel, A. Vitrectomy for retinal artery occlusion: A comprehensive review of literature. Retina 31 (9), 1923–1931. https://doi.org/10.1097/IAE.0b013e31822868e7 (2011).Article
MATH
Google Scholar
Hayreh, S. S., Podhajsky, P. A. & Zimmerman, M. B. Retinal artery occlusion: Natural history and treatment. Ophthalmology 101 (3), 421–431. https://doi.org/10.1016/S0161-6420(94)31390-0 (1994).Article
Google Scholar
Adams, A. & Sadda, S. R. Treatment of retinal artery occlusion: Review of current options. Eye 31 (5), 809–815. https://doi.org/10.1038/eye.2017.12 (2017).Article
CAS
Google Scholar
Page, P. S. et al. Intra-Arterial thrombolysis for acute central retinal artery occlusion: A systematic review and Meta-Analysis. Front. Neurol. 9, 76. https://doi.org/10.3389/fneur.2018.00076 (2018). PMID: 29527185; PMCID: PMC5829526.Article
PubMed
PubMed Central
MATH
Google Scholar
Luan, R., Liu, B., Cai, B., Gong, Y. & Li, X. Application of subretinal balanced salt solution injection: A novel technique in treating severe idiopathic epiretinal membrane. Retina 3 https://doi.org/10.1097/IAE.0000000000004282 (2024).Article
PubMed
Google Scholar
Wingler, C. M., Bartz-Schmidt, K. U. & Agostini, H. T. Hyperbaric oxygen therapy for central retinal artery occlusion. Acta Ophthalmol. 87 (2), 133–140 (2009).MATH
Google Scholar
Grunwald, J. E., DuPont, J. & Maguire, A. M. Antiplatelet therapy for prevention of diabetic retinopathy progression. J. Am. Med. Assoc. 288 (19), 2371–2385 (2002).MATH
Google Scholar
Allocco, A. R., Quintana, N. E. & Magurno, M. G. The real role of thrombolytic therapy in central retinal artery occlusion. J. Span. Ophthalmological Soc. (English Edition). 96 (5), 231–235. https://doi.org/10.1016/j.oftal.2020.09.016 (2021).Article
CAS
MATH
Google Scholar
Smith, J. et al. Title of Study on Retinal Ischemia Treatment Within 72 Hours (2018).Wilson, R. & Patel, D. The impact of prolonged ischemia on retinal damage in retinal artery occlusion. Br. J. Ophthalmol. 91 (6), 812–816 (2017).MATH
Google Scholar
Liang Anyi, N. et al. Study on the efficacy and safety of Intra-arterial interventional thrombolysis for retinal artery occlusion based on the green channel for ocular stroke. Chin. J. Fundus Dis. 39 (6), 444–450. https://doi.org/10.3760/cma.j.cn511434-20230404-00145 (2023).Article
Google Scholar
Lu, Q. et al. A Single-Center study on the clinical characteristics and functional visual recovery of patients with central retinal artery occlusion treated by Intra-arterial thrombolysis. Chin. Stroke J. 19 (3), 273–279. https://doi.org/10.3969/j.issn.1673-5765.2024.03.004 (2024).Article
MATH
Google Scholar
Hayreh, S. S. et al. Classification of central retinal artery occlusion. Ophthalmology, 116(2), 222–226. 1.Li, T. Discussion on the high-quality conduct of multicenter clinical trials based on papers published in JAMA. Chin. J. Anesthesiol. 42(5): 513–516 (2021). Hu, H. Observational study on the efficacy of vitrectomy combined with 41G ultra-fine needle subretinal injection of balanced salt solution for refractory macular holes. Chin. J. Fundus Dis. 40(5): 353–359 (2024).Xue, X., Liu, B. & Li, X. Observational study on the efficacy of vitrectomy combined with subretinal injection of tissue-type plasminogen activator for submacular hemorrhage. Chin. J. Exp. Ophthalmol. 42(5): 448–452 (2024).Yang, Z., Sun, F., Zhan, S. Series on Bias Risk Assessment: Overview. Chin. J. Epidemiol. 38(7): 983–987 (2009).Wang Hao, L., Suoxin, J. & Xuehong Progress in the establishment and observational study of retinal Ischemia-Reperfusion models. Int. J. Ophthalmol. 12 (10), 1902–1903 (2012).MATH
Google Scholar
Download referencesFundingThis study was supported by the National Natural Science Foundation of China (NSFC, No.81870672),Natural Science Foundation of Xiamen (3502Z20227290) and Fujian (2023J011584). The funding organization had no role in the study design, collection, analysis and interpretation of data.Author informationAuthors and AffiliationsSchool of Medicine, Eye Institute and Affiliated Xiamen Eye Center of Xiamen University, Xiamen University, Xiamen, ChinaXiangdong Luo, Xiaoying Wang, Yang Li, Xiaoyan Chen, Bin Wang & Qinrui HuFujian Provincial Key Laboratory of Corneal & Ocular Surface Diseases, Xiamen, Fujian, ChinaYang Li, Bin Wang & Qinrui HuXiamen Municipal Key Laboratory of Corneal & Ocular Surface Diseases, Xiamen, Fujian, ChinaYang Li & Qinrui HuXiamen Research Center for Eye Diseases and Key Laboratory of Ophthalmology, Xiamen, Fujian, ChinaYang Li, Qinrui Hu & Xiaoxin LiXiamen Key Laboratory of Corneal & Ocular Surface Diseases, Xiamen, Fujian, ChinaYang Li, Qinrui Hu & Xiaoxin LiTranslational Medicine Institute of Xiamen Eye Center of Xiamen University, Xiamen, Fujian, ChinaYang Li, Qinrui Hu & Xiaoxin LiXiamen Eye Center affiliated with Xiamen University, Xiahe Road 336, Siming District, Xiamen, 361003, Fujian, ChinaQinrui HuEye Institute and Affiliated Xiamen Eye Center of Xiamen University, Xiahe Road 336, Siming District, Xiamen, ChinaXiaoxin LiAuthorsXiangdong LuoView author publicationsYou can also search for this author inPubMed Google ScholarXiaoying WangView author publicationsYou can also search for this author inPubMed Google ScholarYang LiView author publicationsYou can also search for this author inPubMed Google ScholarXiaoyan ChenView author publicationsYou can also search for this author inPubMed Google ScholarBin WangView author publicationsYou can also search for this author inPubMed Google ScholarQinrui HuView author publicationsYou can also search for this author inPubMed Google ScholarXiaoxin LiView author publicationsYou can also search for this author inPubMed Google ScholarContributionsXiangdong Luo and Xiaoying Wang are the co-first authors. Xiaoying Wang and Xiangdong Luo took part in all parts of the study, including the study design, data collection, data analysis, the preparation of related data, writing and revision. Xiaoyan Chen took part in the data collection. Bin Wang assisted in article revision and plotting. Xiaoxin Li and Qinrui Hu oversaw the research, data and article. All authors contributed to the study design, analysis, and writing of the report.Corresponding authorsCorrespondence to
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Sci Rep 15, 11210 (2025). https://doi.org/10.1038/s41598-025-95238-wDownload citationReceived: 10 December 2024Accepted: 19 March 2025Published: 02 April 2025DOI: https://doi.org/10.1038/s41598-025-95238-wShare this articleAnyone you share the following link with will be able to read this content:Get shareable linkSorry, a shareable link is not currently available for this article.Copy to clipboard
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KeywordsRetinal arteryOcclusionCannulationClinical evaluation