Maldonado Filipa, Reis da Silva Alexandre, A Ramos Rui, Gaio-Lima Clara, Castro Ana, Ferreira António Pedro, Camacho Óscar, Teixeira Carla
Department of Anesthesiology, Unidade Local de Saúde de Matosinhos - Hospital Pedro Hispano, Matosinhos, PRT.
Department of Ophthalmology, Unidade Local de Saúde de Matosinhos - Hospital Pedro Hispano, Matosinhos, PRT.
Cureus. 2024 Aug 5;16(8):e66196. doi: 10.7759/cureus.66196. eCollection 2024 Aug.
Background Central retinal artery occlusion (CRAO) results in sudden, painless vision loss. As an analogous condition to acute ischemic stroke, CRAO is an ophthalmological emergency, but a standardized treatment is lacking. Hyperbaric oxygen therapy (HBOT) has been widely used in spite of the inconsistent results reported. Purpose To report the visual acuity (VA) outcomes in all patients submitted to HBOT with non-arteritic CRAO in a tertiary center. Methods This retrospective study included all adult patients with CRAO and symptoms lasting for less than 24 hours who were prescribed HBOT in the Hyperbaric Medicine Unit of a Portuguese hospital from March 2009 to February 2023. Patient demographic information, medical history, ophthalmologic evaluation, hospital of referral, time until HBOT, supplementary treatments, number of HBOT sessions, adverse effects, and patient subjective VA gain were collected. All patients were subjected to 90-minute HBOT sessions with 100% oxygen at 2.4 ATA. The primary outcome was VA change (dif-logMAR) before and after treatment. A clinically significant visual improvement was defined as a dif-logMAR≥0.3. Data were analyzed using IBM SPSS Statistics for Windows, Version 29 (Released 2021; IBM Corp., Armonk, New York, United States) (p<0.05 is considered significant). Results A total of 114 patients were included in this study; 68% (n=77) were male, with a mean age of 69 years, and were subjected to a median number of seven HBOT sessions. No serious adverse effects from HBOT were reported. The mean time delay from symptoms to treatment was 12 hours, and best-corrected visual acuity (BCVA) at baseline was counting fingers or worse in 84% (n=96) of the patients. A dif-logMAR≥0.3 occurred in 46% (n=52) of the patients, and 58% (n=66) reported subjective VA improvement after the treatment. A significant improvement between BCVA before HBOT (2.12±0.74) and after HBOT (1.67±0.74) was observed. The VA outcome was found to be related to the total number of sessions, age, obesity, supplementary treatments, and cherry-red spot (CRS) at presentation. There were no significant effects of the time delay from symptoms to treatment in the explanation of the VA outcome. Conclusions HBOT appears to be safe and has a beneficial effect on VA outcomes in patients with non-arteritic CRAO, particularly depending on the number of sessions. Patient factors such as age, obesity, and the presence of CRSs also appear to influence the VA outcome.
视网膜中央动脉阻塞（CRAO）会导致突然的、无痛性视力丧失。作为急性缺血性卒中的类似病症，CRAO是一种眼科急症，但缺乏标准化治疗方法。尽管报道的结果不一致，高压氧疗法（HBOT）仍被广泛应用。
报告在一家三级中心接受HBOT治疗的所有非动脉炎性CRAO患者的视力（VA）结果。
这项回顾性研究纳入了2009年3月至2023年2月在葡萄牙一家医院高压医学科接受HBOT治疗的所有成年CRAO患者，其症状持续时间少于24小时。收集患者的人口统计学信息、病史、眼科评估、转诊医院、至HBOT的时间、辅助治疗、HBOT疗程数、不良反应以及患者主观视力提高情况。所有患者均接受90分钟的HBOT疗程，使用100%氧气，压力为2.4ATA。主要结局是治疗前后的视力变化（差值-logMAR）。临床显著的视力改善定义为差值-logMAR≥0.3。使用IBM SPSS Statistics for Windows，版本29（2021年发布；IBM公司，美国纽约州阿蒙克）进行数据分析（p<0.05被认为具有统计学意义）。
本研究共纳入114例患者；68%（n=77）为男性，平均年龄69岁，接受HBOT的中位数为7个疗程。未报告HBOT的严重不良反应。从症状出现到治疗的平均延迟时间为12小时，84%（n=96）的患者基线最佳矫正视力（BCVA）为眼前手动或更差。46%（n=52）的患者差值-logMAR≥0.3，58%（n=66）的患者报告治疗后主观视力有所改善。观察到HBOT前BCVA（2.12±0.74）与HBOT后（1.67±0.74）有显著改善。发现视力结果与疗程总数、年龄、肥胖、辅助治疗以及就诊时的樱桃红斑（CRS）有关。症状出现到治疗的延迟时间对视力结果的解释没有显著影响。
HBOT似乎是安全的，对非动脉炎性CRAO患者的视力结果有有益影响，特别是取决于疗程数。年龄、肥胖和CRS的存在等患者因素似乎也会影响视力结果。
