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Interventions for acute non-arteritic central retinal artery occlusion

  • Review
  • Intervention

Authors


Abstract

Background

Acute central retinal artery occlusion (CRAO) occurs as a sudden interruption of the blood supply to the retina and results in an almost complete loss of vision in the affected eye. There is no generally agreed treatment regimen although a number of therapeutic interventions have been proposed.

Objectives

The objective of this review was to examine the effects of treatments used for acute non-arteritic CRAO.

Search methods

We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (which contains the Cochrane Eyes and Vision Group Trials Register) (The Cochrane Library, Issue 3, 2008), MEDLINE (January 1966 to September 2008), EMBASE (January 1980 to September 2008) and the reference lists of relevant papers.

Selection criteria

We included randomised controlled trials (RCTs) only in which one treatment aimed to re-establish blood supply to the retina in people with acute CRAO was compared to another treatment.

Data collection and analysis

Two authors independently assessed the search results for relevant trials. Discrepancies were resolved by discussion.

Main results

We found two RCTs that met our inclusion criteria.

Authors' conclusions

The included studies in this review were small and from single centres. Neither study was completely clear about it's method of treatment allocation. One study described the use of pentoxifylline tablets (three 600 mg tablets daily) and the other the use of enhanced external counterpulsation (EECP) combined with haemodilution. Both studies indicated improved retinal perfusion in the non-control group but neither showed an improvement in vision. Large, well-designed RCTs are still required to establish the most effective treatment for acute CRAO. These studies should be looking at factors important to the patient i.e. improved vision with acceptable risk/side-effects.

摘要

背景

急性非動脈之中央視網膜動脈阻塞的介入措施

急性中央視網膜動脈阻塞(Acute central retinal artery occlusion (CRAO))是發生流向視網膜的血液突然中斷且造成受影響的眼睛幾乎完全失明。雖然有一些治療介入措施已被提出,但沒有普遍認同的治療方法。

目標

這篇回顧的目的是評估用於急性非動脈CRAO之治療方法的效果。

搜尋策略

我們檢索the Cochrane Central Register of Controlled Trials (CENTRAL) (其包含the Cochrane Eyes and Vision Group Trials Register) (The Cochrane Library,2008年,第3期),MEDLINE (1966年1月至2008年9月),EMBASE (1980年1月至2008年9月)及相關文章的參考文獻。

選擇標準

我們只納入針對急性CRAO病患重建血液供給到視網膜的治療方法對照於另一種治療方法的隨機對照試驗(randomised controlled trials (RCTs))。

資料收集與分析

兩名作者分別評估相關試驗的研究結果。經由討論以解決評估後不一致的結果。

主要結論

我們發現兩篇符合我們納入標準的RCTs。

作者結論

這篇回顧納入的研究是小型的且資料來自單一的中心。皆不清楚這兩篇研究其治療方法分派的方法。一篇研究描述使用pentoxifylline藥片(每天三片600毫克),而另一篇研究使用體外加強博衝治療系統(enhanced external counterpulsation (EECP))合併血液稀釋。這兩篇研究指出非對照組其視網膜灌注獲得改善,但兩篇皆未顯示對於視力的改善。未來仍需要大型,設計良好的RCTs以建立對於急性CRAO最有效的治療方法。這些研究應注意對於病患重要的因素,如為了改善視力可接受的風險/副作用。

翻譯人

本摘要由高雄榮民總醫院金沁琳翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

中央視網膜動脈阻塞發生在當供給視網膜(眼睛內的光線敏感層)內部的血液突然中斷時。如果及時解決阻塞的問題,並使血液回復供給到視網膜,則有可能完全康復。然而,如果阻塞的時間延長則視網膜會壞死。各種的方法已經被嘗試用於解決阻塞的問題包括按摩眼睛,降低眼內壓及溶解血栓的藥物。這些方法中何者對於重建血液供給是最好的目前仍不知道,且有一些方法與嚴重的副作用有關。這篇回顧發現兩篇研究,其認為血液供給視網膜可以經由使用他們所試驗的治療方法而被改善-雖然兩篇研究的方法並未顯示可以改善研究族群的視力。然而,這些研究是小型的且的確有潛在的缺點,因此需要更多的研究。

Plain language summary

Treatments for acute central retinal artery occlusion (blockage of the blood supply to the retina of the eye)

Central retinal artery occlusion occurs when the blood supply to the inner part of the retina (the light sensitive layer inside the eye) is suddenly stopped. If the blockage is removed in time, and the blood supply returns to the retina, full recovery is possible. However, if the blockage is prolonged the retina dies. Various methods have been tried in an attempt to remove the blockage including massaging the eye, lowering the pressure inside the eye and dissolving clots with drugs. Which of these methods is best for re-establishing the blood supply is not known and some of the treatments can be associated with serious adverse effects. This review did find two studies that suggested that the blood supply to the retina could be improved with the treatments they tested - although vision was not shown to be improved with either method in the study population. These were, however, small studies and did have potential flaws so more research is still needed.

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