Kim Boyoung M, Wang Kenny Y, Xu Timothy T, Hooshmand Sara J, Toups Gary N, Millman Martha P, Steinkraus Lawrence W, Tooley Andrea A, Barkmeier Andrew J, Chen John J
From the Alix School of Medicine, Mayo Clinic (B.M.K., K.Y.W.), Rochester, Minnesota, USA.
Department of Ophthalmology, Mayo Clinic (T.T.X., A.A.T., A.J.B., J.J.C.), Rochester, Minnesota, USA.
Am J Ophthalmol. 2025 Jan;269:393-401. doi: 10.1016/j.ajo.2024.09.027. Epub 2024 Oct 4.
To describe the outcomes of hyperbaric oxygen therapy (HBOT) for patients with central retinal artery occlusion (CRAO) at a single tertiary care center.
Retrospective clinical cohort study.
Medical records of all patients diagnosed with CRAO who received HBOT at Mayo Clinic in Rochester, Minnesota from January 1, 2009 to December 31, 2020 were reviewed to confirm diagnosis, time from onset to presentation, exam findings, treatments, and follow-up data. Main outcome measures included final visual acuity (VA) and number of lines of improvement.
There were 41 patients diagnosed with CRAO who received HBOT during the 12-year study period. Median time from symptom onset to HBOT treatment was 9.5 h (interquartile range [IQR] 6.5, 14.0 h), and patients received a median of 4 HBOT sessions (IQR 2.5, 6.0 sessions). There were 20 patients who received HBOT within 9 h, 14 (70%) of which had clinically meaningful improvement in VA of ≥0.3 logMAR. In comparison, of the 21 patients treated after 9 h, 6 (28.6%) had VA improvement of ≥0.3 logMAR (P = .008). For all patients, the median logMAR VA at presentation was 2.00 (IQR 1.70, 2.30) and the median logMAR VA at follow-up was 1.94 (IQR 1.00, 2.00) (P < .001), with median lines of improvement of 3.0 (IQR 0.0, 7.0). For patients treated within 9 h, the median logMAR VA at presentation was 2.00 (IQR 1.93, 2.30) and the median logMAR VA at follow-up was 1.70 (IQR 0.54, 2.00). Patients treated within 9 h had statistically significant greater median lines of VA improvement than cases that were treated after >9 h from symptom onset at 5.9 (IQR 3.0, 10.0) and 0.0 (IQR 0.0, 3.0), respectively (P < .001). There was no difference in VA recovery associated with specific retinal exam findings such as cherry-red spot (P = .22) and cilioretinal artery perfusion (P = .36) compared to patients without those findings.
There was a statistically significant improvement in VA after HBOT treatment in CRAO patients among patients that received early HBOT, with patients receiving the most benefit when receiving treatment within 9 h. Randomized control trials in patients with CRAO are required to confirm the efficacy of HBOT.
描述在单一三级医疗中心对视网膜中央动脉阻塞（CRAO）患者进行高压氧治疗（HBOT）的结果。
回顾性临床队列研究。
回顾了2009年1月1日至2020年12月31日在明尼苏达州罗切斯特市梅奥诊所接受HBOT治疗的所有诊断为CRAO患者的病历，以确认诊断、从发病到就诊的时间、检查结果、治疗方法和随访数据。主要结局指标包括最终视力（VA）和视力改善行数。
在12年的研究期间，有41例诊断为CRAO的患者接受了HBOT治疗。从症状发作到HBOT治疗的中位时间为9.5小时（四分位间距[IQR]为6.5，14.0小时），患者接受HBOT治疗的中位次数为4次（IQR为2.5，6.0次）。有20例患者在9小时内接受了HBOT治疗，其中14例（70%）的VA有临床意义的改善，改善幅度≥0.3 logMAR。相比之下，在9小时后接受治疗的21例患者中，有6例（28.6%）的VA改善幅度≥0.3 logMAR（P = 0.008）。对于所有患者，就诊时的中位logMAR VA为2.00（IQR为1.70，2.30），随访时的中位logMAR VA为1.94（IQR为1.00，2.00）（P < 0.001），中位改善行数为3.0（IQR为0.0，7.0）。对于在9小时内接受治疗的患者，就诊时的中位logMAR VA为2.00（IQR为1.93，2.30），随访时的中位logMAR VA为1.70（IQR为0.54，2.00）。症状发作后9小时内接受治疗的患者，其VA改善的中位数行显著高于症状发作后>9小时接受治疗的患者，分别为5.9（IQR为3.0，10.0）和0.0（IQR为0.0，3.0）（P < 0.001）。与没有樱桃红斑（P = 0.22）和睫状视网膜动脉灌注（P = 0.36）等特定视网膜检查结果的患者相比，有这些检查结果的患者在VA恢复方面没有差异。
在接受早期HBOT治疗的CRAO患者中，HBOT治疗后VA有统计学意义的改善，在9小时内接受治疗的患者获益最大。需要对CRAO患者进行随机对照试验以确认HBOT的疗效。
