A 67-year-old man presented with right central retinal artery occlusion (visual acuity: 20/2000) 17 hours after symptom onset and underwent vitrectomy at 20 hours. Cannulation with a 48-gauge microneedle and tissue plasminogen activator (tPA) injection rendered the artery transparent (A). After tPA infusion for 3 minutes, arterial massage was applied using a soft-tip cannula. Subsequently, fragmented emboli migrated toward the peripheral retinal arterioles (B, arrows), a phenomenon observed multiple times. With no bleeding at the puncture site under normal infusion pressure, the procedure was concluded. Preoperative (C) and postoperative day 1 (D) OCT angiography confirmed reperfusion, and visual acuity improved marginally to 20/500. Earlier presentation and intervention may have better visual outcome.
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