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Stephen M. Hypes, Ashkan Abbey, Yoshihiro Yonekawa, Jeremy D Wolfe; Exacerbation of Macular Edema Associated with Hyperbaric Oxygen Therapy. Invest. Ophthalmol. Vis. Sci. 2016;57(12):2678.
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© ARVO (1962-2015); The Authors (2016-present)
Hyperbaric oxygen therapy (HBOT) is being marketed as a treatment for retinovascular diseases without scientific evidence. HBOT has been shown to increase VEGF levels in tissues; therefore, we hypothesize HBOT may in fact worsen the vascular permeability of diseased retinal vasculature. We report a patient who developed an abnormally acute and diffuse macular edema from a preexisting retinal arterial macroaneurysm (RAM) following HBOT.
Retrospective clinical analysis of visual acuity (VA), spectral domain optical coherence tomography (SD-OCT), and fluorescein angiography (FA) before and after administration of HBOT in a 71-year-old woman with a preexisting RAM.
The patient presented with acute onset of blurry vision OS. BCVA was 20/200, and examination revealed submacular hemorrhage OS and a new RAM as seen on FA. The patient underwent vitrectomy with subretinal tissue plasminogen activator and pneumatic displacement. VA improved to 20/150 one week after surgery. One week post-operative SD-OCT showed trace residual subretinal fluid, and no intraretinal edema. In the following weeks, the patient underwent 7 consecutive sessions of HBOT. At post-operative week 5, VA OS had decreased to 20/200 and a new, acute, diffuse, and severe macular edema was noted. Fluorescein angiography demonstrated increased leakage from the RAM and surrounding angiopathic vessels. The patient was directed to discontinue HBOT, and the edema quickly resolved with intravitreal ranibizumab treatment.
HBOT may exacerbate macular edema from retinovascular diseases. We recommend that retinovascular disease not be listed as an indication, but as a relative contraindication for HBOT, until proven otherwise.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
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