Efficacy and safety of hyperbaric oxygen therapy for acute central retinal artery occlusion in Hong Kong: results of the first 3 years

Authors

  • Sunny, Chi Lik Au Tung Wah Eastern Hospital image/svg+xml
  • Steffi, Shing Yee Chong
  • Po Lin Leow
  • Callie, Ka Li Ko

DOI:

https://doi.org/10.12809/hkjo-v26n1-323

Keywords:

COVID-19, Hyperbaric Oxygenation, Retinal arterial microaneurysm, Retinal artery occlusion

Abstract

Purpose: To review the efficacy and safety of hyperbaric oxygen therapy (HBOT) for central retinal artery occlusion (CRAO) in Hong Kong patients.
Methods: Patients diagnosed with CRAO with symptom onset ≤6 hours who failed emergency bedside ocular treatment were referred to a course of HBOT. Changes in best corrected visual acuity (VA) after HBOT and adverse effects and complications of HBOT were recorded. Changes in best corrected VA between the pre-COVID-19 group and the COVID-19-pandemic group were compared.
Results: 34 men and 26 women with CRAO aged 27 to 89 years were included for analysis. The mean follow-up period was 169±226 days. The mean number of HBOT sessions received was 8.6±3.2. The mean best corrected VA improved from 2.02±0.36 to 1.53±0.61 logMAR after HBOT (p<0.00001). 65% of patients had improvement and 33.3% had no improvement. VA changes between the pre-COVID-19 group (n=22) and COVID-19-pandemic group (n=38) were comparable (-0.53±0.58 vs -0.46±0.57 logMAR, p=0.59), despite a delay in hospital attendance. 41.7% of patients failed to equalize the pressure during treatment requiring myringotomy or even grommet insertion. 20% of patients had barotrauma. Other adverse events included convulsion, confusion, sinus pain, and hypoglycemia.
Conclusion: In patients with CRAO, HBOT is effective in improving best corrected VA, even during the COVID-19 pandemic.

References

1. Flaxel CJ, Adelman RA, Bailey ST, et al. Retinal and Ophthalmic Artery Occlusions Preferred Practice Pattern®. Ophthalmology 2020;127:P259-P287. DOI: https://doi.org/10.1016/j.ophtha.2019.09.028

2. Au SCL, Ko CKL. Ocular stroke and COVID-19. Hong Kong Med J 2021;27:231. DOI: https://doi.org/10.12809/hkmj219296

3. Varma DD, Cugati S, Lee AW, Chen CS. A review of central retinal artery occlusion: clinical presentation and management. Eye (Lond) 2013;27:688-97. DOI: https://doi.org/10.1038/eye.2013.25

4. Cugati S, Varma DD, Chen CS, Lee AW. Treatment options for central retinal artery occlusion. Curr Treat Options Neurol 2013;15:63-77. DOI: https://doi.org/10.1007/s11940-012-0202-9

5. Dumitrascu OM, Newman NJ, Biousse V. Thrombolysis for central retinal artery occlusion in 2020: time is vision! J Neuroophthalmol 2020;40:333-45. DOI: https://doi.org/10.1097/WNO.0000000000001027

6. Kim YS, Nam MS, Park EJ, et al. The effect of adjunctive hyperbaric oxygen therapy in patients with central retinal artery occlusion. Undersea Hyperb Med 2020;47:57-64. DOI: https://doi.org/10.22462/01.03.2020.7

7. Wu X, Chen S, Li S, et al. Oxygen therapy in patients with retinal artery occlusion: a meta-analysis. PLoS One 2018;13:e0202154. DOI: https://doi.org/10.1371/journal.pone.0202154

8. Yip LT, Au SCL, Ko CKL. Hyperbaric oxygen therapy for central retinal artery occlusion: experience in Hong Kong. Hong Kong J Ophthalmol 2020;24:44-50. DOI: https://doi.org/10.12809/hkjo-v24n2-281

9. Au SCL, Ko CKL. Impact of COVID-19 on acute central retinal artery occlusion patient attendance in Hong Kong: the HORA study brief report number 2. Acta Sci Clin Case Rep 2021;2:1-2.

10. Au SCL. Central retinal artery occlusion in COVID-19. Indian J Ophthalmol 2021;69:2905-6. DOI: https://doi.org/10.4103/ijo.IJO_1803_21

11. Au SCL, Ko CKL. Comments on coronavirus positive patients presenting with stroke-like symptoms. J Stroke Cerebrovasc Dis 2021;30:105741. DOI: https://doi.org/10.1016/j.jstrokecerebrovasdis.2021.105741

12. Au SCL, Ko CKL. Prevalence of SARS-CoV-2 among central retinal artery occlusion patients: a case series-HORA study report No. 3. J Acute Dis 2021;10:147-9. DOI: https://doi.org/10.4103/2221-6189.318644

13. Au SCL, Ko CKL. Delayed hospital presentation of acute central retinal artery occlusion during the COVID-19 crisis: the HORA study brief report No. 4. Indian J Ophthalmol 2021;69:2904-5. DOI: https://doi.org/10.4103/ijo.IJO_2005_21

14. Schmidt I, Walter P, Siekmann U, et al. Development of visual acuity under hyperbaric oxygen treatment (HBO) in non arteritic retinal branch artery occlusion. Graefes Arch Clin Exp Ophthalmol 2020;258:303-10. DOI: https://doi.org/10.1007/s00417-019-04568-9

15. Wang J, Huang J, Cheung CSK, Wong WN, Cheung NT, Wong MC. Adoption of an electronic patient record sharing pilot project: cross-sectional survey. J Med Internet Res 2020;22:e13761. DOI: https://doi.org/10.2196/13761

16. 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. DOI: https://doi.org/10.1007/s00417-008-0926-0

17. Ledolter J, Gramlich OW, Kardon RH. Display of data. Invest Ophthalmol Vis Sci 2020;61:25. DOI: https://doi.org/10.1167/iovs.61.6.25

18. O'Neill OJ, Weitzner ED. The O'Neill grading system for evaluation of the tympanic membrane: a practical approach for clinical hyperbaric patients. Undersea Hyperb Med 2015;42:265-71.

19. Hadanny A, Maliar A, Fishlev G, et al. Reversibility of retinal ischemia due to central retinal artery occlusion by hyperbaric oxygen. Clin Ophthalmol 2016;11:115-25. DOI: https://doi.org/10.2147/OPTH.S121307

20. Mir TA, Arham AZ, Fang W, et al. Acute vascular ischemic events in patients with central retinal artery occlusion in the United States: a nationwide study 2003-2014. Am J Ophthalmol 2019;200:179-86. DOI: https://doi.org/10.1016/j.ajo.2019.01.009

21. Chodnicki KD, Tanke LB, Pulido JS, et al. Stroke risk before and after central retinal artery occlusion: a population-based analysis. Ophthalmology 2022;129:203-8. DOI: https://doi.org/10.1016/j.ophtha.2021.07.017

22. Chodnicki KD, Pulido JS, Hodge DO, Klaas JP, Chen JJ. Stroke risk before and after central retinal artery occlusion in a US cohort. Mayo Clin Proc 2019;94:236-41. DOI: https://doi.org/10.1016/j.mayocp.2018.10.018

23. Chang YS, Jan RL, Weng SF, et al. Retinal artery occlusion and the 3-year risk of stroke in Taiwan: a nationwide population-based study. Am J Ophthalmol 2012;154:645-52.e1. DOI: https://doi.org/10.1016/j.ajo.2012.03.046

24. Nasole E, Zanon V, Marcolin P, Bosco G. Middle ear barotrauma during hyperbaric oxygen therapy; a review of occurrences in 5,962 patients. Undersea Hyperb Med 2019;46:101-6. DOI: https://doi.org/10.22462/04.06.2019.2

25. Karahatay S, Yilmaz YF, Birkent H, Ay H, Satar B. Middle ear barotrauma with hyperbaric oxygen therapy: incidence and the predictive value of the nine-step inflation/deflation test and otoscopy. Ear Nose Throat J 2008;87:684-8. DOI: https://doi.org/10.1177/014556130808701210

26. Edinguele WFOP, Barberon B, Poussard J, Thomas E, Reynier JC, Coulange M. Middle-ear barotrauma after hyperbaric oxygen therapy: a five-year retrospective analysis on 2,610 patients. Undersea Hyperb Med 2020;47:217-28. DOI: https://doi.org/10.22462/04.06.2020.7

27. Peleg RK, Fishlev G, Bechor Y, et al. Effects of hyperbaric oxygen on blood glucose levels in patients with diabetes mellitus, stroke or traumatic brain injury and healthy volunteers: a prospective, crossover, controlled trial. Diving Hyperb Med 2013;43:218-21.

28. Stevens SL, Narr AJ, Claus PL, et al. The incidence of hypoglycemia during HBO2 therapy: a retrospective review. Undersea Hyperb Med 2015;42:191-6.

29. Baitule S, Patel AH, Murthy N, et al. A systematic review to assess the impact of hyperbaric oxygen therapy on glycaemia in people with diabetes mellitus. Medicina (Kaunas) 2021;57:1134. DOI: https://doi.org/10.3390/medicina57101134

30. Murphy-Lavoie H, Butler F, Hagan C. Arterial inefficiencies: central renal artery occlusion. In: Lindell KW, editor. Hyperbaric Oxygen Therapy Indication, 13th ed. Durham, NC: Best Publishing Company; 2014: 11-24.

31. Pereira LS, Yoon MK, Hwang TN, et al. Giant cell arteritis in Asians: a comparative study. Br J Ophthalmol 2011;95:214-6. DOI: https://doi.org/10.1136/bjo.2009.177220

32. Au SCL. A surge in eye clinic nonattendance under 2019 novel coronavirus outbreak. Indian J Ophthalmol 2020;68:948. DOI: https://doi.org/10.4103/ijo.IJO_673_20

Downloads

Published

2022-06-29

Issue

Section

Original Articles

How to Cite

1.
Efficacy and safety of hyperbaric oxygen therapy for acute central retinal artery occlusion in Hong Kong: results of the first 3 years. Hong Kong J Ophthalmol [Internet]. 2022 Jun. 29 [cited 2026 Jul. 27];26(1). Available from: https://hkjo.hk/index.php/hkjo/article/view/323

Similar Articles

1-10 of 51

You may also start an advanced similarity search for this article.

Most read articles by the same author(s)