Early Hyperbaric Oxygen Treatment for Nonarteritic Central Retinal Artery Obstruction

• Published in: American journal of ophthalmology 2012-03, Vol.153 (3), p.454-459.e2
• Main Authors: Menzel-Severing, Johannes, Siekmann, Ullrich, Weinberger, Andreas, Roessler, Gernot, Walter, Peter, Mazinani, Babac
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Biological and medical sciences; Female; Follow-Up Studies; Giant Cell Arteritis - therapy; Hemodilution; Humans; Hyperbaric Oxygenation; Male; Medical sciences; Middle Aged; Miscellaneous; Ophthalmology; Retinal Artery Occlusion - physiopathology; Retinal Artery Occlusion - therapy; Retreatment; Retrospective Studies; Treatment Outcome; Visual Acuity - physiology
• ISSN: 0002-9394; 1879-1891
• DOI: 10.1016/j.ajo.2011.08.009

Purpose To compare hyperbaric oxygen treatment combined with hemodilution with hemodilution only in central retinal artery obstruction. Design Retrospective, nonrandomized case series. Methods We reviewed records of all our patients diagnosed with central retinal artery obstruction between 1997 and 2010. In these patients, hyperbaric oxygen and hemodilution therapy had been administered routinely (oxygen group). Where hyperbaric oxygenation could not be performed, patients were underwent hemodilution only (control group). Patients with presenting visual acuity (VA) of up to 20/200 within 12 hours of onset were included in our analysis. Exclusion criteria included cilioretinal vessels or arteritic occlusion. Results The oxygen group comprised 51 patients, and the control group comprised 29 patients. Mean baseline VA was counting fingers (oxygen group) and 20/1000 (control group; P = .1). Most other potential confounders, including duration of symptoms, also did not differ significantly at baseline. In the oxygen group, mean VA improvement was 3 lines ( P < .0001). This was sustained over a follow-up of 3 months ( P = .01). In the control group, mean improvement was 1 line ( P = .23 at discharge, P = .17 at follow-up). Differences between both groups were not significant ( P = .07 at discharge, P = .26 at follow-up). The number of patients gaining 3 lines or more was 38.0% versus 17.9% at discharge ( P = .06) and 35.7% versus 30.8% at follow-up ( P = .76). Conclusions We saw significant VA improvement after the combined treatment, but not when using hemodilution only. Confirming superiority of the combination treatment requires a randomized, prospective trial. A high number of nonresponders highlights the need to improve our understanding and treatment of hypoxia-related metabolic insults after central retinal artery obstruction.