Treating Acute Central Retinal Artery Occlusion with Tenecteplase
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Reviewed & Translated by Dat Tien Nguyen, B.A, ScM.
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Posted on March 9th, 2026
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Obstruction of the central retinal artery by a thrombus abruptly disrupts ocular blood flow, leading to ischemic injury of the retina and, if left untreated, permanent vision loss. Despite the severity of this condition, no intervention has consistently demonstrated clinical benefit. Although thrombolytic therapy is well established in the management of acute ischemic stroke, its effectiveness in central retinal artery occlusion remains uncertain. To assess whether stroke-based thrombolytic strategies could be applied to ocular ischemia, a study was conducted to evaluate the use of tenecteplase in patients with acute central retinal artery occlusion.
Funding Source(s): Oslo University Hospital
This phase 3 clinical trial was conducted in Norway and enrolled 78 participants with a mean age of 71 years. Most cases of retinal artery occlusion were attributed to carotid artery atherosclerosis. All participants presented with severe visual impairment in the affected eye and met the inclusion criterion of a best-corrected visual acuity of at least 1.0 logMAR, indicating vision so reduced that objects visible at 60 meters to a person with normal vision could only be seen at 6 meters.
Participants were randomly assigned to receive either intravenous placebo in the form of aspirin or intravenous tenecteplase at a dose of 300 mg, administered within 4.5 hours of symptom onset. Tenecteplase promotes clot dissolution by binding to fibrin and enhancing plasmin-mediated thrombolysis. At 30-day follow-up, treatment with tenecteplase did not result in a statistically significant improvement in visual outcomes. Moreover, its use was associated with an increased risk of hemorrhagic complications. The investigators suggested that the lack of therapeutic benefit, despite the ischemic mechanism of the disease, may be explained by fundamental anatomical and physiological differences between retinal and cerebral vasculature, which may limit the effectiveness of systemic thrombolysis in retinal ischemia.
Funding Source(s): Oslo University Hospital
This phase 3 clinical trial was conducted in Norway and enrolled 78 participants with a mean age of 71 years. Most cases of retinal artery occlusion were attributed to carotid artery atherosclerosis. All participants presented with severe visual impairment in the affected eye and met the inclusion criterion of a best-corrected visual acuity of at least 1.0 logMAR, indicating vision so reduced that objects visible at 60 meters to a person with normal vision could only be seen at 6 meters.
Participants were randomly assigned to receive either intravenous placebo in the form of aspirin or intravenous tenecteplase at a dose of 300 mg, administered within 4.5 hours of symptom onset. Tenecteplase promotes clot dissolution by binding to fibrin and enhancing plasmin-mediated thrombolysis. At 30-day follow-up, treatment with tenecteplase did not result in a statistically significant improvement in visual outcomes. Moreover, its use was associated with an increased risk of hemorrhagic complications. The investigators suggested that the lack of therapeutic benefit, despite the ischemic mechanism of the disease, may be explained by fundamental anatomical and physiological differences between retinal and cerebral vasculature, which may limit the effectiveness of systemic thrombolysis in retinal ischemia.