Successful Intravenous Thrombolysis of Central Retinal Artery Occlusion in a Patient with Giant Cell Arteritis
Bibliographic record
Abstract
Importance: Central retinal artery occlusion (CRAO) is an ophthalmologic emergency, most often from non-arteritic etiology, but occasionally due to arteritic causes, especially giant cell arteritis (GCA), an inflammatory vasculitis affecting large and medium sized arteries. While thrombolytic therapy with intravenous tissue plasminogen activator (IV tPA) has gathered interest in non-arteritic CRAO, its role in arteritic CRAO remains unexplored. We report a case of successful visual recovery following intravenous thrombolysis in a patient with GCA-associated CRAO, and compare this outcome with current literature. Observations: A patient presenting with acute monocular vision loss in her left eye was diagnosed with CRAO in the setting of active GCA and received IV tPA within 2.5 hours of symptom onset. Visual acuity, fundus findings, and safety outcomes were documented post-treatment. Following treatment, the patient demonstrated significant visual improvement, regaining functional acuity. This contrasts sharply with the typically poor visual prognosis in arteritic CRAO, despite corticosteroid therapy alone. In non-arteritic CRAO, IV tPA, when administered within 4.5 hours, has been shown to improve vision in 30–60% of cases, with an excellent safety profile and very low incidence of symptomatic intracranial hemorrhage. No previous studies however have reported successful thrombolysis in arteritic CRAO. Conclusion: This case presents new evidence that early intravenous thrombolysis, in conjunction with corticosteroid therapy, may preserve vision in GCA-related CRAO by targeting a superimposed thrombotic component. While current guidelines do not support thrombolysis for arteritic CRAO, our findings suggest that a dual anti-inflammatory and thrombolytic approach could be effective in select patients. Further research is warranted to characterize patient selection criteria, optimize timing, and assess safety in this unique population.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.002 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.000 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".