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Andrea Tooley, Maya Maloney, Andrew Barkmeier; Clinical outcomes of central retinal artery occlusion following prompt management with hyperbaric oxygen therapy. Invest. Ophthalmol. Vis. Sci. 2016;57(12):5152.
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© ARVO (1962-2015); The Authors (2016-present)
Central retinal artery occlusion (CRAO) is often visually devastating and there are no proven treatments. Hyperbaric oxygen therapy (HBOT) has been used by some, but it is not widely available and limited prior reports have not demonstrated its superiority to other interventions, such as ocular massage, anterior chamber paracentesis, or ocular antihypertensive medications. We report clinical outcomes of patients treated with HBOT within 24 hours of CRAO.
We reviewed medical records of 27 consecutive patients diagnosed with CRAO between 10/2009 and 9/2015 who underwent HBOT within 24 hours of symptom onset. The diagnosis of CRAO was made based on characteristic fundoscopic exam or by fluorescein angiography. The primary outcome was change in visual acuity (VA) following HBOT. VA was converted to logMAR units for data analysis with the following conversions: count fingers (CF) at 2 feet (2’/200) = 2.0, hand motion (HM) = 3.0. VA of light perception (LP) and no light perception (NLP) were analyzed separately.
27 patients were diagnosed with CRAO and treated with HBOT and 5 had perfused cilioretinal arteries. The mean time from symptom onset to presentation was 7.3 hours (range 2-22h). The mean initial VA was 2.36 (1’/CF, n=20, range 20/40 to NLP); 7 patients were excluded due to LP/NLP VA (6 LP, 1 NLP). The mean initial VA excluding patients with cilioretinal arteries was 2.84 (3’/HM, n=15, range 2’/200 to NLP). The mean initial VA in patients with cilioretinal arteries was 0.91 (20/200, n=5, range 20/40 to 1’/CF). The final mean VA was 1.86 (3’/CF, n=24, range 20/20 to NLP, p=0.31); 3 patients excluded due to LP/NLP VA (2 LP, 1 NLP). The mean final VA excluding patients with cilioretinal arteries was 2.25 (1’/CF, n=19, range 20/30 to NLP, p=0.08). The mean final VA in patients with cilioretinal arteries was 0.39 (20/50, n=5, range 20/20 to 20/400, p= 0.31).
Most patients with CRAO have poor visual outcomes. Mean VA did improve for patients treated with HBOT, but data is sparse regarding how these outcomes compare to natural history or other interventions. Patients with patent cilioretinal arteries experienced better visual outcomes. The rarity of these ischemic events and their devastating nature make it challenging to study potential treatments in a more systematic manner.
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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