Low-dose urokinase thrombolysis combined with papaverine for central retinal artery occlusion: a preliminary exploration of efficacy and safety

Objective To investigate the efficacy and safety of low-dose urokinase combined with papaverin administered via superselective ophthalmic artery thrombolysis in patients with non-arteritic central retinal artery occlusion (CRAO). Methods A retrospective analysis was conducted on the clinical data of 20 CRAO patients who underwent ophthalmic artery thrombolysis at our hospital between December 2023 and July 2025. All procedures were performed under local anesthesia via femoral artery puncture and catheterization. A sequential injection of 400,000 IU urokinase followed by 30 mg papaverine was administered into the ophthalmic artery. Best-corrected visual acuity (BCVA, expressed in logMAR) was assessed pre- and post-operatively, and adverse events were recorded. Results The median time from symptom onset to treatment was 7.25 h (IQR: 2.00–20.50). The mean preoperative BCVA in the affected eye was 2.38 ± 0.93 logMAR, which significantly improved to 0.33 ± 0.26 logMAR postoperatively ( p < 0.001). The median improvement in BCVA was 2.54 logMAR units (IQR: 0.84–2.78). Although a statistically significant difference persisted between the postoperative visual acuity of the affected eye and that of the contralateral healthy eye (0.28 ± 0.26 logMAR) ( p = 0.002), the median difference was only 0.075 logMAR, suggesting limited clinical significance. No serious adverse events, such as hemorrhage or cerebral infarction, occurred in any patient. Conclusion Low-dose urokinase combined with papaverine via ophthalmic artery thrombolysis significantly improved visual acuity with a favorable safety profile in carefully selected CRAO patients, demonstrating potential for clinical application.