Table 3:

Treatments proposed for the treatment of acute central retinal artery occlusion

Mechanism	Proposed effect	Comments
Dislodging emboli	Reperfuse retina
-Ocular massage	Decrease intraocular pressure and induce retinal arteriolar dilation	No effect shown
-Nd:Yag laser embolectomy	Removes embolus	Controversial 50% vitreous hemorrhage
Increasing retinal artery perfusion pressure	Reperfuse retina
-Lower intraocular pressure with medications	Decrease intraocular pressure and induce retinal arteriolar dilation	No effect shown
-Anterior chamber paracentesis	Rapid decrease in intraocular pressure leading to dilation of retinal arteries with subsequent distal migration of embolus	Anecdotal effect
Vasodilation	Stimulates distal migration of embolus
-Hyperventilation or inhalation of carbogen	Increase blood CO2 with subsequent vascular dilation	No effect shown
-Induce vasodilation (sublingual isosorbide dinitrate)	Induce retinal arteriolar dilation with subsequent distal migration of embolus	No effect shown
-Increase erythrocyte flexibility (pentoxifylline)	Increase red blood cell flexibility, reduce blood viscosity, increase tissue perfusion	Shown to increase retinal artery blood flow
Increase blood oxygen tension	Increase amount of oxygen delivered to ischemic retina
-Hyperbaric oxygen	Supportive measure until spontaneous reperfusion of retina occurs	Anecdotal effect
Thrombolysis	Dissolution of fibrin-based clots
-Intravenous tPA	Reperfusion of retina	Retrospective studies with variable results
-Intra-arterial tPA in ophthalmic artery	Selective reperfusion of retina	EAGLE trial negative Retrospective studies with variable results