Hyperbaric oxygen therapy for central retinal artery occlusion: experience in Hong Kong
Keywords:Hyperbaric oxygenation, Retinal artery occlusion
Objective: To review medical records of patients who underwent hyperbaric oxygen therapy (HBOT) for central retinal artery occlusion (CRAO).
Methods: Medical records of patients who underwent HBOT for CRAO between November 2018 and December 2019 were reviewed. The first emergency HBOT was at 2.8 atmosphere absolute for 90 minutes with staged decompression. Subsequent sessions were at 2.4 atmosphere absolute twice daily or daily. Patients were followed up daily at the eye clinic. HBOT lasted for 5 days or 10 treatment sessions if there was visual improvement on day 3. Treatments were discontinued if patients had no visual improvement or were unable to tolerate the treatment or experienced major adverse effects, or when the patient was confirmed to not have CRAO.
Results: Of 31 patients who underwent HBOT, 25 with CRAO (17 men, 8 women; aged 44 to 89 years) were included. Mean onset-to-door time was 3.3±4.2 hours, and mean onset-to-HBOT time was 13.3±7.4 hours. Mean number of HBOT sessions was 7.9±2.7. Mean change in visual acuity (VA) was -0.43 LogMAR (p=0.003). At the end of treatment, 84% had VA of 0.1 (1.0 logMAR) or worse and 64% had VA of finger counting (1.7 logMAR) or worse. No factors were associated with VA improvement including age, onset-to-door time, onset-to-HBOT time, number of HBOT sessions, or pre-HBOT VA.
Conclusion: HBOT for CRAO shows promising visual outcomes. It is important to be aware of the systemic complication of CRAO and provide timely systemic cardiovascular work up for CRAO patients.
von Graefe A. Ueber Embolie der Arteria centralis retinae als Urasche plötzlicher Erblindung. Archiv fur Ophthalmologie 1859;5:136-57.
Leavitt JA, Larson TA, Hodge DO, Gullerud RE. The incidence of central retinal artery occlusion in Olmsted County, Minnesota. Am J Ophthalmol 2011;152:820-3.e2.
Park SJ, Choi NK, Yang BR, et al. Risk and risk periods for stroke and acute myocardial infarction in patients with central retinal artery occlusion. Ophthalmology 2015;122:2336-43.e2.
Hayreh SS, Zimmerman MB. Central retinal artery occlusion: visual outcome. Am J Ophthalmol 2005;140:376-91.
Weber J, Remonda L, Mattle HP, et al. Selective intra-arterial fibrinolysis of acute central retinal artery occlusion. Stroke 1998;29:2076-9.
Rumelt S, Dorenboim Y, Rehang U. Aggressive systematic treatment for central retinal artery occlusion. Am J Ophthalmol 1999;128:733-8.
Petterson JA, Hill MD, Demchuk AM, et al. Intra-arterial thrombolysis for retinal artery occlusion: the Calgary experience. Can J Neurol Sci 2005;32:507-11.
Kadonosono K, Yamane S, Inoue M, Yamakawa T, Uchio E. Intra-retinal arterial cannulation using a microneedle for central retinal artery occlusion. Sci Rep 2018;8:1360.
Atebara NH, Brown GC, Cater J. Efficacy of anterior chamber paracentesis and carbogen in treating acute nonarteritis central retinal artery occlusion. Ophthalmology 1995;102:2029-35.
Mueller AJ, Neubauer AS, Schaller U, Kampik A; European Assessment Group for Lysis in the Eye. Evaluation of minimally invasive therapies and rationale for a prospective randomized trial to evaluate selective intra-arterial lysis for clinically complete central retinal artery occlusion. Arch Ophthalmol 2003;121:1377-81.
Rudkin AK, Lee AW, Aldrich E, Miller NR, Chen CS. Clinical characteristics and outcome of current standard management of central retinal artery occlusion. Clin Exp Ophthalmol 2010;38:496-501.
Fraser S, Siriwardena D. Interventions for acute non-arteritic central retinal artery occlusion. Cochrane Database Syst Rev 2002;1:CD001989.
Lindell K Weaver MD. Undersea and Hyperbaric Medical Society. Hyperbaric Oxygen Therapy Indications, 13th Ed.
Li HK, Dejean BJ, Tang RA. Reversal of visual loss with hyperbaric oxygen treatment in a patient with Susac syndrome. Ophthalmology 1996;103:2091-8.
Buras JA, Garcia-Covarrubias L. Ischemia-reperfusion injury and hyperbaric oxygen therapy. Basic mechanisms and clinical studies. In: Neuman TS, Thom SR, editors. Physiology and Medicine of Hyperbaric Oxygen Therapy. 1st ed. Philadelphia: Saunders Elsevier; 2008.
Lange C, Feltgen N, Junker B, Schulze-Bonsel K, Bach M. Resolving the clinical acuity categories 'hand motion' and 'counting fingers' using the Freiburg Visual Acuity Test (FrACT). Graefes Arch Clin Exp Ophthalmol 2009;247:137-42.
Murphy-Lavoie H, Butler F, Hagan C. Central retinal artery occlusion treated with oxygen: a literature review and treatment algorithm. Undersea Hyperb Med 2012;39:943-53.
Hayreh SS, Zimmerman MB, Kimura A, Sanon A. Central retinal arterial occlusion. Retinal survival time. Exp Eye Res 2004;78:723-36.
Hayreh SS, Weingeist TA. Experimental occlusion of the central artery of the retina. I. Ophthalmoscopic and fluorescein funds angiographic studies. Br J Ophthalmol 1980;64:896-912.
Hayreh SS. So-called “central retinal vein occlusion”. I. Pathogenesis, terminology, clinical features. Ophthalmologica 1976;172:1-13.
Rumelt S, Brown GC. Update on treatment of retinal arterial occlusions. Curr Opin Ophthalmol 2003;14:139-41.
Masters TC, Westgard BC, Hendriksen SM, et al. Case series of hyperbaric oxygen therapy for central retinal artery occlusion. Retin Cases Brief Rep 2019.
Mangat HS. Retinal artery occlusion. Surv Ophthalmol 1995;40:145-56.
Brown GC, Shields JA. Cilioretinal arteries and retinal arterial occlusion. Arch Ophthalmol 1979;97:84-92.
Hayreh SS, Kolder HE, Weingeist TA. Central retinal artery occlusion and retinal tolerance time. Ophthalmology 1980;87:75-8.
David NJ, Norton EW, Gass JD, Beauchamp J. Fluorescein angiography in central retinal artery occlusion. Arch Ophthalmol 1967;77:619-29.
Augsburger JJ, Magargal LE. Visual prognosis following treatment of acute central retinal artery obstruction. Br J Ophthalmol 1980;64:913-7.
Zhang XZ, Cao JQ. Observations on therapeutic results in 80 cases of central serous retinopathy created with hyperbaric oxygenation. Presented at the 5th Chinese Conference on Hyperbaric Medicine, Fuzhou, China, 26-29 September 1986.
Camporesi EM, Bosco G. Mechanisms of action of hyperbaric oxygen therapy. Undersea Hyperb Med 2014;41:247-52.
Beard T, Warriner RA, Pascer P, et al. Adverse events during hyperbaric oxygen therapy (HBOT). A retrospective analysis from 25 centers. UHMS Scientific Assembly, Las Vegas, 2005.
Hampson N, Atik D. Central nervous system oxygen toxicity during routine hyperbaric oxygen therapy. Undersea Hyperb Med 2003;30:147-53.
Leach RM, Rees PJ, Wilmshurst P. Hyperbaric oxygen therapy. BMJ 1998;317:1140-3.
Sheffield PJ, Desautels DA. Hyperbaric and hypobaric chamber fires: a 73-year analysis. Undersea Hyperb Med 1997;24:153-64.
Evanger K, Haugen OH, Irgens A, Aanderud L, Thorsen E. Ocular refractive changes in patients receiving hyperbaric oxygen administered by oronasal mask or hood. Acta Ophthalmol Scand 2004;82:449-53.
Feldelius HC, Jansen EC, Thorn J. Refractive change during hyperbaric oxygen therapy. A clinical trial including ultrasound oculometry. Acta Ophthalmol Scand 2002;80:188-90.
Palmquist BM, Philipson B, Barr PO. Nuclear cataract and myopia during hyperbaric oxygen therapy. Br J Ophthalmol 1984;68:113-7.
Tang PH, Engel K, Parke DW 3rd. Early onset of ocular neovascularization after hyperbaric oxygen therapy in a patient with central retinal artery occlusion. Ophthlamol Ther 2016;5:263-9.
Wagner BP, Lindenbaum E, Logue CJ, et al. Rethinking the standard of care for patients with central retinal artery occlusion. Ann Emerg Med 2017;70:S105.
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