Hyperbaric oxygen in the treatment of retinal arterial occlusion

Purpose: To retrospectively determine if hyperbaric oxygen (HBO) may play a role in improving visual outcome in patients with significant visual acuity loss from retinal arterial occlusions and the effect of time to treatment on prognosis. Methods: Eight eyes in 7 patients who had retinal artery occlusion and experienced significant visual acuity loss underwent HBO treatment. They were analyzed as to their final visual improvement compared to their time to treatment. Meta-analysis was also performed using our data and 3 previously described series where the data was available (total 34 cases). Results: Average visual acuity gains in our series were 4.4 levels for those treated within 8 hours and 2.7 for those treated >8 hours from symptoms. Fifty percent gained >3 levels of acuity with final vision 20/100 or better. In the meta-analysis, visual improvement was best for the 0-2 hour group, followed by 2-8, then 8-24, then >24 hour groups. When all data was considered, the level of visual gain for cases treated within 2 hours and within 8 hours were each statistically better than those cases treated >24 hours. Fifty percent of all patients gained >3 levels of visual acuity and had final acuity of 20/100 or better. Conclusions: HBO may be a useful tool in the treatment of retinal artery occlusion with visual loss. Time to treatment is likely the most important factor in prognosis. Larger, prospective, randomized and controlled studies are currently planned to conclusively determine the role of HBO in treatment of this devastating condition.