Management of central retinal artery occlusion following successful hyperbaric oxygen therapy: case report

Abstract

Objective: This case report presents a patient with central retinal artery occlusion (CRAO) who was successfully treated with hyperbaric oxygen (HBO 2) but subsequently suffered a recurrence of his visual loss. Methods: CRAO may be treated successfully with HBO 2 if treatment is undertaken promptly after the onset of vision loss. The goal of HBO2 therapy is to oxygenate the ischemic inner retinal layers via diffusion from the hyperoxygenated choroidal circulation until recanalization of the central retinal artery occurs. Results: A 71-year-old man presented with hand motion vision and fundus findings of CRAO in his left eye. Treatment with HBO 2 was initiated approximately 9.5 hours after loss of vision. The patient experienced return of vision to a near-normal level during HBO 2. His vision loss recurred, however, 15 minutes after the HBO 2 session. There was a delay to follow-up HBO 2 treatments, and the improvement of vision that resulted from these subsequent HBO 2 sessions was much less than that experienced during his initial HBO 2 treatment. Conclusions: Recovery of vision during initial HBO 2 treatment indicated that this patient's retina had not yet suffered irreversible ischemic damage at that point in time. CRAO patients with a good result from initial HBO 2 treatment should be admitted to a stroke center and should have their visual status monitored hourly. Should vision loss recur, aggressive use of intermittent 100% normobaric and hyperbaric oxygen is indicated to preserve retinal function until central retinal artery recanalization occurs. An evidence-based management plan for such patients is presented.

Case Series of Hyperbaric Oxygen Therapy for Central Retinal Artery Occlusion

“…However, other authors have noted positive outcomes when supplementing therapy with HBO with normobaric oxygen, which should be considered in future trials. 16,23,25 While our HBO treatment course was standardized, the other therapies provided to these patients varied, such as antiplatelet medications, anterior chamber paracentesis, statins, antihypertensive agents, and, in one case, thrombolytics, which is similar to practice variations reported in other trials. 35 The ophthalmologic evaluations that these patients received also did occasionally vary.…”

Hyperbaric oxygen therapy as rescue therapy for pediatric frosted branch angiitis with Purtscher-like retinopathy: A case report

“…In an earlier animal study by Landers, the visual evoked response (VER) was restored to normal despite retinal artery occlusion while 1 ATA oxygen was administered. Normal VER indicated that the inner retinal layers were adequately oxygenated in this model ( 6 , 11 ).…”

“…Most importantly, according to Henry’s law, the amount of dissolved oxygen increases in proportion to the increased partial pressure of oxygen. For instance, if 100% oxygen is breathed at 3 ATA (≈ 2,280 mmHg), dissolved oxygen rises from 0.31 to 6.02 vol%, which theoretically provides sufficient oxygen to maintain the basic metabolism of the human body without oxygen from hemoglobin ( 6 ). In an earlier animal study by Landers, the visual evoked response (VER) was restored to normal despite retinal artery occlusion while 1 ATA oxygen was administered.…”

“…Hyperbaric oxygen therapy (HBOT) has been used to treat blindness, including central retinal artery occlusion, macular Abbreviations: ATA, atmosphere absolute; BCVA, best-corrected visual acuity; FBA, frosted branch angiitis; HBOT, hyperbaric oxygen therapy; OCT, optical coherence tomography; PuR, Purtscher-like retinopathy; ANA, antinuclear antibody. edema due to diabetes, and specific optic neuropathy (4)(5)(6). We report a case utilizing HBOT as a rescue treatment for macular ischemia in post-viral infection-induced FBA and PuR.…”

“…Hyperbaric oxygen therapy (HBOT) has been used to treat blindness, including central retinal artery occlusion, macular edema due to diabetes, and specific optic neuropathy ( 4 – 6 ). We report a case utilizing HBOT as a rescue treatment for macular ischemia in post-viral infection-induced FBA and PuR.…”