Abstract:AIM: To evaluate the effectiveness and safety of superselective ophthalmic artery thrombolysis (SOAT) for central retinal artery occlusion (CRAO) beyond 24h after onset. METHODS: This was a retrospective cohort study of CRAO patients treated from January 2019 to July 2025. Patients were divided into four groups by treatment (SOAT/conservative) and onset-to-treatment time (<24h/>24h). Main outcome measures were best-corrected visual acuity (BCVA, logMAR) and central macular thickness (CMT) assessed via spectral-domain optical coherence tomography (SD-OCT), recorded at baseline, 3d and 1mo after treatment. Ocular/systemic adverse events were documented. RESULTS: A total of 109 CRAO participants were enrolled, including 74 males (67.89%) and 35 females (32.11%), with a mean age of 52.30±11.76y. Underlying diseases were hypertension (78 cases, 71.56%), diabetes (40 cases, 36.70%), arterial atherosclerosis with plaque formation (81 cases, 74.31%), hyperlipidemia (14 cases, 12.84%), and hypercholesterolemia (16 cases, 14.68%). Four groups included 25, 28, 26, and 30 cases in Groups 1 (SOAT<24h), 2 (SOAT>24h), 3 (conservative <24h), and 4 (conservative >24h), respectively. In <24h cohort, BCVA improved significantly in both Group 1 (2.36±0.53 to 1.71±0.81 logMAR, P<0.05) and Group 3 (2.42±0.40 to 1.92±0.76 logMAR, P<0.05). In >24h cohort, thrombolysis improved BCVA (1.84±0.88 to 1.31±0.53 logMAR, P<0.05), while conservative treatment showed no significant change (2.04±0.74 to 1.92±0.73 logMAR, P=0.808). Clinically significant improvement (≥0.3 logMAR) was more frequent with SOAT in both time windows (P<0.05). SOAT significantly reduced CMT in both <24h (256±25.65 to 209±21.22 μm, P<0.001) and >24h groups (242±23.33 to 204±27.22 μm, P<0.001), while conservative treatment had no significant effect on CMT (all P>0.05). Adverse events included orbital swelling (11.3%), new cerebral infarction (7.55%), dizziness/headache (7.55%), and nausea/vomiting (5.66%). No intracranial hemorrhage occurred. CONCLUSION: SOAT provides meaningful visual and anatomical benefit even beyond 24h after symptom onset. However, potential ocular and systemic adverse events necessitate careful patient selection and individualized risk assessment.
