Objective: In this study, we aimed at exploring the effect and safety of local intra-arterial thrombolysis on acute central retinal artery occlusion. Methods: Retrospective data analysis of 49 consecutive acute central retinal occlusion patients was performed. All the patients were treated with urokinase perfusion through the ophthalmology artery within the first 6 hours after central retinal artery occlusion attack. Conventional treatments including intra-ocular pressure decreasing, microcirculation improvement, neuroprotection and antiplatelet aggregation were conducted. The visual acuity (with International Snellen Chart) and field of vision were detected after thrombolysis. The complications and adverse events were observed. Results: Recanalization was found in 71% of patients. The visual acuity improvement was greater in the recanalization group (n = 35) than in the non-recanalization group (n = 14). The averaged visual acuity was 0.15 +/- 0.02, 0.25 +/- 0.03 and 0.4 +/- 0.05 after 2, 28 days and 6 months, respectively. Of the patients, 24.5% regained > 0.6 of visual acuity, and the visual field deficit was less than 30% in 34.7% of patients after 28 days. Six months later, 36.7% patients regained visual acuity of > 0.6, and the field deficit was less than 30% in 44.9% of patients. The difference between visual acuity in recanalization (0.6 +/- 0.04) and non-recanalization (0.002 +/- 0.0012) patients after 6 months after thrombolysis was significant (p < 0.05). Conclusions: Intra-arterial thrombolysis could obviously improve the short- and long-term visual function for patients with acute central retinal artery occlusion within 6 hours of symptom onset. [Neurol Res 2009; 31: 385-389]