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Ethan K Sobol,1,2 Yu Sakai,3 Danielle Wheelwright,3 Carl S Wilkins,1,2 Amanda Norchi,1 Michael G Fara,4 Christopher Kellner,3 James Chelnis,1 J Mocco,3 Richard B Rosen,1,2 Reade A De Leacy,3 Gareth MC Lema1,2 1Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA; 2Department of Ophthalmology, New York Eye and Ear Infirmary of Mount Sinai, New York, NY, 10003, USA; 3Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA; 4Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USACorrespondence: Gareth MC LemaDepartment of Ophthalmology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY, 10029, USATel +1 212-241-0939Fax +1 212-824-2325Email gareth.lema@mssm.eduPurpose: To investigate the benefit of early intra-arterial tissue plasminogen activator (IAT) for treatment of central retinal artery occlusion (CRAO).Patients and Methods: Fifteen eyes of 15 patients presenting with acute CRAO were included in this retrospective consecutive interventional case series. Patients were excluded if treatment with IAT was not initiated within 12 hours. The diagnosis was confirmed by an ophthalmologist. IAT was performed via a transfemoral arterial approach. Tissue plasminogen activator (tPA) was infused into the ophthalmic artery in aliquots up to 3mg to a maximum of 22mg. Paracentesis was done at the ophthalmologist’s discretion. The primary outcome measure was visual acuity after three weeks. Adverse events were recorded during treatment and follow-up visits.Results: After treatment with IAT, there was a statistically significant improvement in visual acuity, with a mean change of − 0.76 (SD 0.91; range − 2.4 to 0.85) logMAR (p=0.006). Vision improved by 3 or more lines in 53%, and of these, the mean Snellen visual acuity improvement was > 6 lines. Notably, 4 patients (27%) improved from CF or worse to 20/80 or better. The mean dose of tPA used was 17mg and the mean time to treatment was 8.83 hours (range: 5.5 to 12 hours). There were no statistically significant differences based on time to treatment, dose of tPA, or use of a paracentesis. No major adverse events were recorded.Conclusion: IAT was safe and showed significant visual improvement in this small uncontrolled study. Larger studies and efforts to decrease time to treatment should be initiated to optimize outcomes.Keywords: CRAO, tPA, intervention, treatment, ophthalmic artery

I saggi di questa raccolta affrontano la questione delle trasformazioni urbane privilegiando una precisa angolazione: quella secondo la quale sensibili benefici per lo sviluppo delle città possono essere raggiunti sulla base delle capacità che queste dimostrano nel costituire delle efficaci forme di aggregazione degli interessi - una community governance - al fine di perseguire una direzione di crescita la cui portata eccede l'ordinaria amministrazione. Gli autori ritengono che i principali dilemmi posti dalla crescita possano essere convenientemente affrontati attraverso l'utilizzo di nuovi strumenti di pianificazione la cui comparsa è relativamente recente. A tali strumenti ci si riferisce con i termini 'convenzionali' di pianificazione strategica, di cultural planning o di city marketing, sottintendendo con queste definizioni ambiti e settori d'intervento specifici e anche molto diversi tra loro. Le differenze, tuttavia, non sembrano essere altrettanto importanti quanto il fatto che, nelle loro premesse, questi strumenti condividono un medesimo scopo: quello di convincere molti attori, di diversi ambiti funzionali e istituzionali, a formare delle agende politiche come strategie di mobilitazione intorno ad ampie e non convenzionali questioni di problem-solving. Il volume fa parte di un progetto editoriale che presenta lo stato dell'arte della sociologia urbana italiana.