Article
Hyperbaric oxygenation to treat central retinal artery obstruction
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Published: | June 15, 2011 |
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Outline
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No treatment is currently available to prevent lasting visual loss from retinal artery obstruction. Under hyperbaric conditions the amount of oxygen dissolved in serum can be increased substantially, also augmenting the provision of oxygen to the retina. This constitutes the rationale behind the putative usefulness of hyperbaric oxygen treatment (HBOT) in acute central retinal artery obstruction (CRAO). Here, we compare the outcome of HBOT in CRAO-patients to that of controls. Records of all patients diagnosed with CRAO at the RWTH Aachen University were reviewed. HBOT and hemodilution therapy had been administrated routinely. If systemic contra-indications impeded HBOT or if HBOT was unavailable, patients were hemodiluted only; this group was regarded as controls. Patients were included if seen within 12 hours of onset and if visual acuity (VA) was ≤1/40. Among exclusion criteria figured cilioretinal vessels or arteritic occlusion. The HBOT-group comprised 51 patients; 29 patients entered the control group. Mean baseline VA was counting fingers in HBOT-patients and 1/50 in controls (p=0.1). Most other potential confounders (e.g. duration of symptoms) also did not significantly differ at baseline. Upon discharge, VA had improved by a mean of three lines in HBOT-patients (p<0.0001) and one line in controls (p=0.23). We recorded improvement of VA following HBOT, but measured no significant improvement following standard treatment. A randomized, controlled trial would be desirable to confirm these results. A high number of non-responders reinforces the notion that improved understanding of metabolic insults to the retina other that those related to hypoxia is required.