Sokolowski Sofia A, Räisänen-Sokolowski Anne K, Lundell Richard V
Department of Pathology, Helsinki University, Helsinki, Finland.
Corresponding author: Sofia A Sokolowski, Department of Pathology, Helsinki University, Helsinki, Finland, ORCiD: 0000-0002-7936-1436,
Diving Hyperb Med. 2024 Dec 20;54(4):328-337. doi: 10.28920/dhm54.4.328-337.
A 54-year-old, previously healthy Caucasian male diver was on a 22-day liveaboard diving holiday. During this time, he performed 75 open-circuit dives, of which 72 were with enriched air nitrox. All dives were within recreational length and depth. After the trip he noticed a worsening of vision and his refraction had changed from the previous -3.75/-5.75 to -5.5/-7.75 dioptres. Hyperoxic myopia is a well-known phenomenon after hyperbaric oxygen treatment (HBOT), but related literature in recreational divers is scarce.
A systematic literature review on the effect of a hyperoxic environment on the development of myopia was done according to the PRISMA guidelines. Three databases were searched: Ovid MEDLINE, Scopus, and the Cochrane Library. A risk of bias analysis was done on all articles, and the GRADE approach was used to evaluate the quality of evidence. Articles that had sufficient data were used to synthesise a visualisation of oxygen exposure and changes in refraction.
Twenty-two articles were included in this review. These included five case reports, two case series, nine cohort studies, one randomised controlled trial and five reviews, of which one was systematic. Most articles described HBOT patients' ocular complications, although four articles were diver centric. The synthesis of results suggests that divers tend to get a greater myopic shift with a smaller exposure. However, the data were too heterogeneous to perform meaningful statistical analyses. This review is the first to focus on divers instead of HBOT patients.
The case presented led to a systematic literature review on the effects of hyperbaric oxygen on refractive changes in both HBOT patients and divers. The data were too heterogeneous to make meaningful suggestions on a safety limit to prevent myopisation in diving.
一名54岁、此前身体健康的白人男性潜水员正在进行为期22天的船宿潜水度假。在此期间，他进行了75次开放式潜水，其中72次使用富氧空气氮氧混合气。所有潜水都在休闲潜水的时长和深度范围内。旅行结束后，他注意到视力恶化，其屈光度从前-3.75/-5.75变为-5.5/-7.75。高氧性近视是高压氧治疗（HBOT）后一种众所周知的现象，但休闲潜水员方面的相关文献很少。
根据PRISMA指南，对高氧环境对近视发展的影响进行了系统的文献综述。检索了三个数据库：Ovid MEDLINE、Scopus和Cochrane图书馆。对所有文章进行了偏倚风险分析，并使用GRADE方法评估证据质量。使用有足够数据的文章来综合呈现氧气暴露与屈光度变化的可视化情况。
本综述纳入了22篇文章。其中包括5篇病例报告、2篇病例系列研究、9项队列研究、1项随机对照试验和5篇综述，其中1篇为系统综述。大多数文章描述了HBOT患者的眼部并发症，不过有4篇文章是以潜水员为中心的。结果综合分析表明，潜水员在接触较少氧气的情况下往往会出现更大的近视度数变化。然而，数据过于异质，无法进行有意义的统计分析。本综述是首次聚焦于潜水员而非HBOT患者。
所呈现的病例促使对高压氧对HBOT患者和潜水员屈光变化的影响进行了系统的文献综述。数据过于异质，无法就预防潜水时近视化的安全限度提出有意义的建议。
