Hyperbaric Oxygen Treatment for Central Retinal Artery Occlusion (CRAO)

According to research done by Assaf Rozenberg and colleagues, using hyperbaric oxygen treatment (HBOT) as part of the standard of care (SOC) for central retinal artery occlusion (CRAO) enhances the ultimate visual result.

Hyperbaric oxygen treatment (HBOT) is safe and, if accessible, can be adopted as part of SOC at all tertiary medical centers. The intake of 100 percent oxygen at pressures of more than one atmosphere absolute (ATA) is used in hyperbaric oxygen treatment (HBOT) to increase the quantity of oxygen dissolved in human tissues.

The goal of this study was to evaluate the visual outcomes of patients treated for non-arthritic central retinal artery occlusion (CRAO) in a medical center that employs hyperbaric oxygen treatment (HBOT) as part of the standard of care (SOC) to those treated in a medical center that does not. The findings of this work were published in the Journal Eye of Nature on 17th June 2021.

Data from two tertiary medical centers were used in the study. The medical records of all patients diagnosed with non-arthritic CRAO without a patent cilioretinal artery in two tertiary medical institutions between January 2010 and December 2018 were reviewed. According to a qualified neurologist's judgment, all patients received a neurological examination that included neuroimaging. All patients at both medical centers received SOC therapy, which comprised:

• Ocular massage
• Anterior chamber paracentesis
• Oral aspirin
• Oral acetazolamide
• Topical beta-blocker

This study found a substantial improvement in VA in CRAO patients treated with HBOT. A mean VA improvement of 0.15 logMAR between presentation and last follow-up visit was not determined to be statistically significant in the control group (who did not get HBOT). After adjusting for age, gender, and duration of symptoms, the final BCVA of the HBOT group was substantially higher than that of the control group. There was no link found between the time of the initial hyperbaric oxygen therapy or the existence of a cherry-red patch and the ultimate visual result.

In conclusion, it appears that HBOT for non-arteritic CRAO outperforms standard therapy in terms of visual results. Given that the proportion of patients obtaining functional eyesight was identical to the control group, additional study is needed to validate the clinical and quality of life consequences of such improvement, as well as the cost-effectiveness of this treatment.

Reference

Rozenberg, A., Hadad, A., Peled, A. et al. Hyperbaric oxygen treatment for non-arteritic central retinal artery occlusion retrospective comparative analysis from two tertiary medical centres. Eye (2021). https://doi.org/10.1038/s41433-021-01617-8