Thanks - the ultimate question is, since I have never seen a successful tPA rescue of a CRAO, can the CF vision, severe field loss, APD occur due to the minutes long periodof ischemia, via tPA (or good luck) restoring circulation, and while the vision loss has occurred and is likely to be permanent, the typical retinal edema and cherry red spot and OCT findings never had a chance to develop? Is this a reasonable scenario, especially for those of you who have seen a rescued CRAO with prompt restoration of circulation with severe persistent loss of vision but zero retina findings?
I left out part of the history, she’s has a PFO which is obviously common, with R->L shunt on bubble study yes, but this is also common, and she is scheduled for PFO closure. I’m reluctant to be the person who says hold off unless it is theoretically possible for this situation to occur fwithr no retina findings after rescue from CRAO with tPA.
Mitch
Original Message:
Sent: 5/11/2026 11:53:00 AM
From: Robert Egan
Subject: RE: CRAO after tPA findings
Mitch,
If you are asking if the fundus findings of a central retina artery occlusion will disappear after successful treatment with TPA, then yes, you should not see any fundus findings of a central retina artery occlusion. However, if the fundus appears normal and the afferent examination is not normal then yes you are likely dealing with a different problem.
Robert
Original Message:
Sent: 05-11-2026 11:34
From: Mitchell Gossman
Subject: CRAO after tPA findings
If a patient with acute vision loss at age 37 is seen in an ER and given tPA given an hour after symptoms of presumed CRAO (no ophthalmology exam), with persistent very poor vision, APD, dense field cut, is it possible for there to be no retina finding at all two weeks later? No cherry red spot, NFL edema on OCT - nothing. A bit of optic nerve pallor maybe, that's all. Color me very skeptical of the presumed diagnosis. (As kind of an aside unrelated to the question, this patient later had pain with eye movement developed a few days later with worsening of vision, the hospital's MRI wa without contrast so getting one with contrast, probably optic neuritis actually).
Mitch