Orwig Drue M, Wang Jianyong, Li Zongyuan, McGlynn John J, HajAissa Naser, Davis Alan, Hovingh Majesta, Packard Laurel, Kooistra Joshua S, Min Jiangyong
Hyperbaric and Wound Care, Division of Vascular Surgery, Corewell Health West and Michigan State University, Grand Rapids, Michigan, USA.
Department of Ophthalmology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.
Am J Emerg Med. 2025 Aug 5;98:1-5. doi: 10.1016/j.ajem.2025.07.065.
Central retinal artery occlusion (CRAO) is a rare form of acute ischemic stroke that causes severe visual loss, which is a relatively rare emergency but devastating eye condition. There is currently no guideline-endorsed treatment for CRAO. Data on hyperbaric oxygen therapy (HBOT) for CRAO is minimal. We aimed to investigate the benefit of HBOT in patients with non-arteritic CRAO.
We conducted a retrospective study from two medical centers that recruited patients with diagnosed non-arteritic CRAO from January 2019 to December 2024. HBOT was offered to CRAO patients who presented to the emergency room within 24 h from symptom onset. Seventeen patients underwent a full course of HBOT (twice a day for five days with a total of 10 HBO treatments). Sixteen CRAO patients received partial HBOT (from 1 to 7 treatments); HBOT was discontinued per patients' request, either due to varied reasons or no noted visual improvement. Thirty-two CRAO patients did not undergo HBOT due to being outside of the treatment window. The primary outcome was visual improvement at the time of discharge. Student's t-test, Mann-Whitney U (Wilcoxon rank sum) test, and Chi-square test were used to compare the change in LogMAR best-corrected visual acuity (BCVA) in patients before and after HBOT.
There was no statistical difference among the three groups in patient demographic and clinical characteristics (vascular risk factors). In the HBOT group, patients who received a full course of HBOT (twice a day for five days) revealed significant visual improvement at discharge evaluation with LogMAR BCVA (p = 0.01). The benefit was not found in patients with partial or no HBOT. Only one patient developed an episode of seizure while receiving HBOT; no complications occurred in the rest of the patients.
HBOT improves visual outcomes in CRAO patients who received an entire course of therapy. The benefit from HBOT does not improve the visual outcome in patients who receive partial or no treatment HBOT. Our results suggest that HBOT is safe and may be considered as a treatment option for patients with CRAO who present to the hospital within 24 h of symptom onset.
视网膜中央动脉阻塞（CRAO）是急性缺血性卒中的一种罕见形式，可导致严重视力丧失，这是一种相对罕见但极具破坏性的眼部疾病。目前尚无指南认可的CRAO治疗方法。关于高压氧疗法（HBOT）治疗CRAO的数据极少。我们旨在研究HBOT对非动脉炎性CRAO患者的益处。
我们对两个医疗中心进行了一项回顾性研究，这些中心招募了2019年1月至2024年12月期间确诊的非动脉炎性CRAO患者。症状发作后24小时内到急诊室就诊的CRAO患者接受了HBOT治疗。17例患者接受了完整疗程的HBOT（每天两次，共五天，总共10次高压氧治疗）。16例CRAO患者接受了部分HBOT治疗（1至7次治疗）；由于各种原因或未观察到视力改善，应患者要求停止了HBOT治疗。32例CRAO患者因超出治疗窗口未接受HBOT治疗。主要结局是出院时的视力改善情况。采用学生t检验、曼-惠特尼U（威尔科克森秩和）检验和卡方检验比较患者在HBOT治疗前后的LogMAR最佳矫正视力（BCVA）变化。
三组患者的人口统计学和临床特征（血管危险因素）无统计学差异。在HBOT组中，接受完整疗程HBOT（每天两次，共五天）的患者在出院评估时LogMAR BCVA显示视力有显著改善（p = 0.01）。部分或未接受HBOT治疗的患者未发现这种益处。只有1例患者在接受HBOT治疗时发生了一次癫痫发作；其余患者未发生并发症。
HBOT可改善接受完整疗程治疗的CRAO患者的视力结局。部分或未接受HBOT治疗的患者未从HBOT中获得视力改善益处。我们的结果表明，HBOT是安全有效的，对于症状发作后24小时内入院的CRAO患者，可考虑将其作为一种治疗选择。
