{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,2]],"date-time":"2025-12-02T18:41:40Z","timestamp":1764700900084,"version":"build-2065373602"},"reference-count":12,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2021,9,13]],"date-time":"2021-09-13T00:00:00Z","timestamp":1631491200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100001818","name":"Research to Prevent Blindness","doi-asserted-by":"publisher","award":["n\/a"],"award-info":[{"award-number":["n\/a"]}],"id":[{"id":"10.13039\/100001818","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: To document, through multimodal imaging, the post-procedural clinical course and visual outcome of a patient who received intra-arterial tissue plasminogen activator (tPA) for acute iatrogenic branch retinal artery occlusion (BRAO), and to review the literature and guidelines regarding the use of tPA for retinal arterial occlusions. Methods: A 28-year-old female patient who sustained an iatrogenic BRAO and subsequently received intra-arterial tPA was followed through her post-interventional course of 3 months with serial exams and multimodal imaging, including color fundus photography, visual field testing, spectral domain optical coherence tomography (SD-OCT), and OCT angiography (OCT-A). Results: A patient with history of left internal cerebral artery (ICA) aneurysm and baseline visual acuity (VA) of 20\/20 developed an acutely symptomatic BRAO after undergoing a neuroendovascular procedure and was acutely treated with tPA through the left ophthalmic artery. At two weeks follow-up, a central posterior pole hemorrhage was noted although VA was preserved. A superior altitudinal defect was shown on automated perimetry. VA dropped to 20\/50 at 7 weeks follow-up and hyperreflective material deep to the attachment between the posterior hyaloid and the internal limiting membrane (ILM) consistent with hemorrhage was noted on SD-OCT. At 11 weeks follow-up, VA returned to 20\/20, SD-OCT revealed a membrane bridging the foveal depression, OCT-A showed decreased vascularity in the inferior macula, and the visual field defect was stable by automated perimetry. Conclusions: Intraocular hemorrhage is a possible complication of intra-arterial tPA administration for BRAO, and a careful analysis of risks, benefits, and goals of this procedure must be considered by both provider and patient before such intervention.<\/jats:p>","DOI":"10.3390\/medicina57090963","type":"journal-article","created":{"date-parts":[[2021,9,13]],"date-time":"2021-09-13T23:32:23Z","timestamp":1631575943000},"page":"963","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Complications of Intra-Arterial tPA for Iatrogenic Branch Retinal Artery Occlusion: A Case Report through Multimodal Imaging and Literature Review"],"prefix":"10.3390","volume":"57","author":[{"given":"Katherine","family":"Dalzotto","sequence":"first","affiliation":[{"name":"Department of Ophthalmology and Visual Sciences, University of Wisconsin School of Medicine and Public Health, Madison, WI 53705, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paige","family":"Richards","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology and Visual Sciences, University of Wisconsin School of Medicine and Public Health, Madison, WI 53705, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tyler D.","family":"Boulter","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology and Visual Sciences, University of Wisconsin School of Medicine and Public Health, Madison, WI 53705, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marilyn","family":"Kay","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology and Visual Sciences, University of Wisconsin School of Medicine and Public Health, Madison, WI 53705, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mihai","family":"Mititelu","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology and Visual Sciences, University of Wisconsin School of Medicine and Public Health, Madison, WI 53705, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2021,9,13]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"818","DOI":"10.1136\/bjo.64.11.818","article-title":"Experimental occlusion of the central artery of the retina. IV: Retinal tolerance time to acute ischaemia","volume":"64","author":"Hayreh","year":"1980","journal-title":"Br. J. Ophthalmol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"723","DOI":"10.1016\/S0014-4835(03)00214-8","article-title":"Central retinal artery occlusion: Retinal survival time","volume":"78","author":"Hayreh","year":"2004","journal-title":"Exp. Eye Res."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"2064","DOI":"10.1161\/STR.0b013e318296aeca","article-title":"An Updated Definition of Stroke for the 21st Century. A Statement for Healthcare Professionals From the American Heart Association\/American Stroke Association","volume":"44","author":"Sacco","year":"2013","journal-title":"Stroke"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"82","DOI":"10.1016\/j.preteyeres.2015.06.001","article-title":"Evidence for an enduring ischaemic penumbra following central retinal artery occlusion, with implications for fibrinolytic therapy","volume":"49","author":"McLeod","year":"2015","journal-title":"Prog. Retin. Eye Res."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1148","DOI":"10.1001\/jamaneurol.2015.1578","article-title":"Intravenous Fibrinolytic Therapy in Central Retinal Artery Occlusion: A Patient-Level Meta-analysis","volume":"72","author":"Schrag","year":"2015","journal-title":"JAMA Neurol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"155","DOI":"10.3340\/jkns.2013.53.3.155","article-title":"Risk factors for developing large emboli following carotid artery stenting","volume":"53","author":"Kwon","year":"2013","journal-title":"J. Korean Neurosurg. Soc."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1367","DOI":"10.1016\/j.ophtha.2010.03.061","article-title":"Central Retinal Artery Occlusion: Local Intra-arterial Fibrinolysis versus Conservative Treatment, a Multicenter Randomized Trial","volume":"117","author":"Schumacher","year":"2010","journal-title":"Ophthalmology"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"2229","DOI":"10.1161\/STROKEAHA.111.613653","article-title":"Efficacy of Intravenous Tissue-Type Plasminogen Activator in Central Retinal Artery Occlusion: Report From a Randomized, Controlled Trial","volume":"42","author":"Chen","year":"2011","journal-title":"Stroke"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"687","DOI":"10.1161\/STROKEAHA.119.027478","article-title":"Thrombolytic Therapy for Acute Central Retinal Artery Occlusion","volume":"51","author":"MacGrory","year":"2020","journal-title":"Stroke"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"333","DOI":"10.1097\/WNO.0000000000001027","article-title":"Thrombolysis for Central Retinal Artery Occlusion in 2020: Time Is Vision!","volume":"40","author":"Dumitrascu","year":"2020","journal-title":"J. Neuro Ophthalmol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"E263","DOI":"10.1055\/s-0032-1312925","article-title":"The retrobulbar \u201cspot sign\u201d as a discriminator between vasculitic and thrombo-embolic affections of the retinal blood supply","volume":"33","author":"Ertl","year":"2012","journal-title":"Ultraschall Med."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"2322","DOI":"10.1161\/STROKEAHA.115.009839","article-title":"Retrobulbar Spot Sign Predicts Thrombolytic Treatment Effects and Etiology in Central Retinal Artery Occlusion","volume":"46","author":"Nedelmann","year":"2015","journal-title":"Stroke"}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/57\/9\/963\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T07:01:32Z","timestamp":1760166092000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/57\/9\/963"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,9,13]]},"references-count":12,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2021,9]]}},"alternative-id":["medicina57090963"],"URL":"https:\/\/doi.org\/10.3390\/medicina57090963","relation":{},"ISSN":["1648-9144"],"issn-type":[{"type":"electronic","value":"1648-9144"}],"subject":[],"published":{"date-parts":[[2021,9,13]]}}}