ABSTRACT NUMBER: ESOC2026A2225 EFFECTIVENESS AND SAFETY OF INTRAVENOUS THROMBOLYSIS FOR NON-ARTERITIC CENTRAL RETINAL ARTERY OCCLUSION: A GRADE-ASSESSED META-ANALYSIS

Abstract Background and aims To evaluate the effectiveness and safety of intravenous thrombolysis (IVT) in patients with non-arteritic central retinal artery occlusion (NA-CRAO), using a GRADE-assessed meta-analysis. Methods A systematic search was conducted across PubMed, Web of Science, Scopus, and Cochrane CENTRAL up to March 2025. Studies eligible included randomized controlled trials (RCTs) and observational designs evaluating IVT (alteplase or tenecteplase) against any comparator in NA-CRAO patients. Visual acuity (VA), visual recovery (VR), and adverse events were analyzed. Meta-analysis was performed using RevMan 5.4, calculating mean differences (MD) and risk differences (RD) with 95% confidence intervals (CI), employing a random-effects model. Risk of bias was assessed using RoB 2.0 and NOS tools. GRADE criteria evaluated evidence certainty. Results Ten studies (3 RCTs, 7 cohorts) involving 579 patients (224 IVT, 325 control) were included. IVT did not significantly improve VA (MD: -0.16; 95% CI: -0.35 to 0.03; P = 0.1) but showed a significant VR benefit (RD: 0.17; number needed to treat (NNT) = 6; 95% CI: 0.09 to 0.25; P < 0.0001), especially with early administration (<4.5 hours; RD: 0.24; NNT = 4). No significant differences in adverse events were found, including symptomatic ICH (RD: 0.00; 95% CI: -0.03 to 0.03). Conclusions IVT significantly improves VR, particularly when administered within 4.5 hours, while no significant improvement in VA was observed except at 1 week. Safety outcomes were comparable to controls. These findings suggest that while IVT does not alter final VA, it may increase the probability of achieving earlier functional recovery within a narrow therapeutic window. Conflict of interest All authors have nothing to disclose. Figure 1 - belongs to Methods Table 1 - belongs to Results Table 2 - belongs to Conclusions