Department of Ophthalmology, University Hospital RWTH Aachen, Aachen, Germany.
Department of Anesthesiology, University Hospital RWTH Aachen, Aachen, Germany.
Graefes Arch Clin Exp Ophthalmol. 2020 Feb;258(2):303-310. doi: 10.1007/s00417-019-04568-9. Epub 2019 Dec 20.
Nonperfusion of retinal tissue due to arterial occlusion leads inevitably to mostly irreversible retinal damage. Until today no evidence-based treatment exists. Inhalation of 100% oxygen at high atmospheric pressure causes an increased solubility of oxygen in the blood that helps the retinal tissue to survive through diffusion in case of an artery occlusion till vascular recanalization occurs. Hence the purpose of this study is to compare the visual outcome in patients with retinal branch artery obstruction treated with hyperbaric oxygen versus patients treated with hemodilution only.
Non-randomized, monocentric, retrospective study. Patients with diagnosis of non-arteritic retinal branch artery occlusion (BRAO) treated with hyperbaric oxygen therapy between 1997 and 2017. Exclusion criteria were central retinal artery occlusion, presence of a cilioretinal artery and arteritic cases. The control group was matched based on visual acuity (VA) at admission, age, and delay between symptoms and beginning of clinical care.
The control group and the matching oxygen group contained 14 patients each. Initial VA in the matched HBO group was 0.18 ± 0.19 and 0.23 ± 0.19 in the control group (p = 0.57). Final VA at discharge was 0.69 ± 0.29 in the matched oxygen group and 0.32 ± 0.23 in the control group (p = 0.0009). HBO-treated patients had a significant visual increase compared with the control group. The most common comorbidities were arterial hypertension and vascular sclerosis.
HBO treatment appears to have a beneficial effect on visual outcome in patients with retinal branch artery occlusion. HBO treatment could be a rescue therapy at an early stage of BRAO, especially to bridge the time of a potential reperfusion. However, further, prospective, randomized clinical trials are required to verify this assumption.
由于动脉阻塞导致视网膜组织无灌注，不可避免地导致大多数视网膜损伤是不可逆转的。直到今天，还没有基于证据的治疗方法。吸入高气压的 100%氧气会增加血液中氧气的溶解度，有助于在动脉阻塞的情况下，通过扩散使视网膜组织存活，直到血管再通发生。因此，本研究的目的是比较高压氧治疗视网膜分支动脉阻塞（BRAO）患者与仅接受血液稀释治疗的患者的视力结果。
非随机、单中心、回顾性研究。纳入 1997 年至 2017 年期间接受高压氧治疗的非动脉炎性视网膜分支动脉阻塞（BRAO）患者。排除标准为中央视网膜动脉阻塞、存在睫状视网膜动脉和动脉炎性病例。对照组根据入院时的视力（VA）、年龄和症状出现与开始临床治疗之间的延迟进行匹配。
对照组和匹配的氧气组各包含 14 名患者。匹配的 HBO 组的初始 VA 为 0.18±0.19，对照组为 0.23±0.19（p=0.57）。出院时的最终 VA 为匹配氧气组 0.69±0.29，对照组 0.32±0.23（p=0.0009）。与对照组相比，接受 HBO 治疗的患者视力显著提高。最常见的合并症是动脉高血压和血管硬化。
HBO 治疗似乎对视网膜分支动脉阻塞患者的视力结果有有益的影响。HBO 治疗可能是 BRAO 的早期挽救性治疗方法，尤其是在潜在再灌注期间。然而，需要进一步的前瞻性、随机临床试验来验证这一假设。
