Article – 1 - Central retinal artery occlusion
Title: Central Retinal Artery Occlusion Treated With Hyperbaric Oxygen.
Authors: Hertzog, LM; Meyer, GW; Carson, S; Strauss, MB; Hart, GB
Digital Object Identifier (or PMID etc): Nil
Keywords: retinal, occlusion, hyperbaric oxygen, visual acuity
Abstract: Seventeen patients, 8 men and 9 females, with an average age of 68 yr, were admitted on 19 occasions (2 with recurrent occlusions) with the diagnosis of central retinal artery occlusion. They were retrospectively grouped into four intensive hyperbaric oxygen (HBO) treatment groups as to onset to treatment: group I treated within 8 h, group II greater than 8 but less than 24 h, group III greater than 24 h from onset to treatment, and all (group IV) a composite of all patients. Improvement was measured by a visual acuity index (VAI). Group I s discharge VAI was significantly improved over the discharge VAI of group II (P = 0.038), group III (P = 0.0006), and the pooled data (P =0.03).
Conclusion: HBO seems useful in preserving visual function when applied within the first 8 h from the onset of occlusion.
Article – 2 - Central retinal artery occlusion
Title: Hyperbaric oxygen treatment of retinal artery occlusion.
Authors: Weiss, JN
Digital Object Identifier (or PMID etc): Nil
Keywords: Nil
Abstract: Five patients with a one- to 12-day history of symptoms secondary to retinal artery occlusion (RAO) were treated with hyperbaric oxygen therapy (HBO2) for one hour at 1.5 ATA. Four patients had been diagnosed with branch retinal artery occlusion (BRAO) and one patient with a cilioretinal artery occlusion. The three patients with macular sparing occlusions had experienced a loss of visual field, and the remaining two patients with macular involvement had marked loss of central visual acuity. All patients improved following HBO2 treatment.
Conclusion: There were no complications. HBO2 may be a safe and effective treatment for patients with RAO.
Article – 3 - Central retinal artery occlusion
Title: Clinical case report: treatment of a central retinal vein occlusion with hyperbaric oxygen.
Authors: Wright, JK; Franklin, B; Zant, E
Digital Object Identifier (or PMID etc): Nil
Keywords: Nil
Abstract: A case of retinal central vein occlusion (CRVO) in a 43-year-old man is presented in which hyperbaric oxygen (HBO2) was used as the only treatment method. CRVO is a relatively common cause of visual loss, with hypertension, diabetes, glaucoma and hypercoagulable conditions identified as risk factors. The patient in this report had none of these risk factors and declined treatments other than hyperbaric oxygen. HBO2 was effective in sustaining the ischemic retina and controlling retinal edema until the retina revascularized and vision stabilized. The initial visual acuity in the left eye was 20/200 (corrected), and after two hyperbaric treatments it was 20/30 (corrected). Following three months of HBO2 treatments the vision stabilized to 20/20 (corrected) in the affected eye.
Conclusion: Treatment considerations in using HBO2 as adjunctive therapy for CRVO are early institution of treatment, and continuation of HBO2 until the retinal edema has resolved and vision has stabilized.
Article – 4 - Central retinal artery occlusion
Title: Hyperbaric oxygen treatment of nonacute central retinal artery occlusion.
Authors: Weiss, JN
Digital Object Identifier (or PMID etc): Nil
Keywords: Nil
Abstract: Four patients received hyperbaric oxygen therapy (HBOT): Three patients had nonarteritic central retinal artery occlusion (CRAO); a fourth patient had a CRAO in the right eye (OD) and a branch retinal artery occlusion (BRAO) with macular involvement in the left eye (OS) secondary to giant cell arteritis. The first two patients presented with a one-day history of CRAO, the third patient with a 10-day history of CRAO OD and the fourth patient with a three-week history of CRAO OD and a three-day history of BRAO OS. The initial visual acuities ranged from light perception to counting fingers at 6 feet. The visual acuity and visual field improved in the first two patients with nonarteritic CRAO. Patients 3 and 4 did not improve.
Conclusion: There were no complications. Hyperbaric oxygen treatment may be safe and effective in selected patients with nonacute, nonarteritic CRAO.
Article – 5 – Central retinal artery occlusion
Title: Retinal artery occlusion: visual outcome after treatment with hyperbaric oxygen.
Authors: Cope, A; Eggert, JV; O'Brien, E
Digital Object Identifier (or PMID etc): Nil
Keywords: Nil
Abstract: We describe a case series of 11 patients with retinal artery occlusion treated with hyperbaric oxygen therapy (HBOT) at Intermountain Dixie Regional Medical Center between 2005 and 2009. We then combined data from our case series with data from two other case series to report on a combined total of 51 patients.
Results: Eight of our 11 patients achieved improved visual acuity. Analysis of the combined case series showed that 74 percent of patients treated with HBOT had improvement in visual acuity (P less than 0.0001) with 53 percent improving two lines or more on a modified Snellen value. The combined case series also showed that visual acuity improved in all time-from-occlusion to treatment categories, ranging from less than 8 hours to six days.
Conclusion: We recommend consideration of HBOT for patients who present with recent retinal artery occlusion. Hyperbaric centres treating these patients should consider forming a central registry of standardised data to prospectively study the results of therapy.
Article – 6 - Central retinal artery occlusion
Title: Neutrophil sequestration and the effect of hyperbaric oxygen in a rat model of temporary middle cerebral artery occlusion
Authors: Atochin, DN; Fisher, D; Demchenko, IT; Thom, SR
Digital Object Identifier (or PMID etc): PMID: 11419358
Keywords: Nil
Abstract: A rat model of reversible occlusion of the middle cerebral artery was developed to assess the role of neutrophils and prophylactic hyperbaric oxygen (HBO2) on cerebral injury. Blood flow to the ipsilateral caudate putamen nucleus was reduced by approximately 50% during 2 h of arterial occlusion, but unaffected on the contralateral side. Neutrophil accumulation in brain was documented as myeloperoxidase concentration, which was elevated in both ipsilateral and contralateral cerebral hemispheres at 1 and 46 h after occlusion/reperfusion. HBO2 administered before ischemia at 2.8 atm abs for 45 min, as well as antibody-induced neutropenia, reduced neutrophil accumulation, functional neurologic deficits, and cerebral infarct volume.
Conclusion: These data demonstrate that one mechanism for benefit of HBO2 is related to its ability to ameliorate post-ischemic injury by inhibiting neutrophil sequestration. This mechanism should be taken into consideration when choosing partial pressures of oxygen for investigational clinical protocols.
Article – 7 - Central retinal artery occlusion
Title: Adjunctive hyperbaric oxygenation in macular edema of vascular origin
Authors: Krott, R; Heller, R; Aisenbrey, S; Bartz-Schmidt, KU
Digital Object Identifier (or PMID etc): PMID: 11419360
Keywords: Nil
Abstract: Macular edema (ME) is a primary reason for permanent decreases of visual acuity (VA) in diabetic retinopathy and retinal vein occlusions. The standard treatment (photocoagulation, rheological treatment) provide only a limited success. We have therefore studied the additional use of hyperbaric oxygenation (HBO2) in patients with persistent ME. Five patients (1 female, 4 male; 7 eyes) were treated by adjunctive HBO2. The average age of the patients was 60.6 (38.9-76.8) yr. The VA was measured with Early Treatment Diabetic Retinopathy Study charts before and after HBO2 with a monthly follow up. Fluorescein angiography was performed before and after HBO2 with a follow up every 3 mo. Each patient received 10-30 HBO2 treatments (median 15). The follow-up period was 15 mo. for every patient. The mean increase in VA was 3.5 (2-4) lines after HBO2. Retinal photocoagulation was performed in six eyes. Diabetic macular edemas showed no morphologic change, while ME originating from retinal vein occlusions (CME) regressed.
Conclusion: The VA in our patients with ME of vascular origin seemed to improve with HBO2. Photocoagulation was necessary in most cases. Visual function correlated with the angiographic presentation only for CME.
Article – 8 - Central retinal artery occlusion
Title: Reduction of apoptosis in ischemic retinas of two mouse models using hyperbaric oxygen treatment.
Authors: Gaydar V, Ezrachi D, Dratviman-Storobinsky O, Hofstetter S, Avraham-Lubin BC, Goldenberg-Cohen N.
Digital Object Identifier (or PMID etc): PMID: 21873680
Keywords: Animals, Apoptosis/physiology, Caspase 3/genetics, Caspase 3/metabolism, Cell Survival, Disease Models, Animal, Hyperbaric Oxygenation, In Situ Nick-End Labeling, Male, Mice, Mice, Inbred C57BL, Mice, Transgenic, Nerve Crush, Optic Neuropathy, Ischemic/genetics, Optic Neuropathy, Ischemic/metabolism, Optic Neuropathy, Ischemic/therapy, Oxidative Stress, Real-Time Polymerase Chain Reaction, Retinal Artery Occlusion/etiology, Retinal Diseases/genetics, Retinal Diseases/metabolism, Retinal Diseases/therapy, Retinal Ganglion Cells/physiology, Retinal Vessels, bcl-2-Associated X Protein/genetics, bcl-2-Associated X Protein/metabolism, bcl-X Protein/genetics, bcl-X Protein/metabolism
Abstract: To investigate the effect of hyperbaric oxygen (HBO) chamber treatment in mouse models of retinal ischemia. Unilateral central retinal artery occlusion (CRAO) or optic nerve crush (ONC) was induced in 50 mice each, of which 30 were treated with 100% oxygen at 2 atm for 90 minutes immediately after injury and then daily for up to 14 days. Mice were euthanatized on days 1, 3, and 21 for histologic analysis, apoptosis assay, and quantitative real-time polymerase chain reaction test. Findings were analyzed by injury and by treatment.
Results: HBO treatment reduced cell loss from 58% to 30% in the CRAO model and from 52% to 32% in the ONC model. In both models, it was associated with significantly increased cell survival in the retinal ganglion cell layer. Expression levels of the proapoptosis genes (bax, caspase-3) decreased minimally in the HBO-treated CRAO mice on day 1, but this trend was reversed on day 3. In the ONC group, levels of caspase-3, bax, and bcl-x increased on day 1 and dropped below baseline on day 3. The pattern of changes in the expression levels of the ischemia- and oxidative-stress-related genes (HO-1, SOD-1, PX-1, NOX-2) and the effectiveness of HBO treatment varied by model. Overall, however, gene expression levels that increased in the untreated mice increased further with HBO treatment and levels that decreased, decreased further with treatment.
Conclusion: HBO treatment protects injured neuronal cells from apoptosis. Response to treatment differs molecularly after ONC or CRAO. These results should prompt clinical trials of acute ischemic retinal damage.
Source URL:
http://www.ncbi.nlm.nih.gov/pubmed/21873680
Full text URL:
http://www.iovs.org/content/52/10/7514.long
Article – 9 - Central retinal artery occlusion
Title: Hyperbaric oxygen therapy and the eye.
Authors: Butler Jr, FK; Hagan, C; Murphy-Lavoie, H
Digital Object Identifier (or PMID etc): Nil
Keywords: Nil
Abstract: Hyperbaric oxygen therapy (HBOT) is a primary or adjunctive therapy for a variety of medical disorders including some involving the eye. This paper is the first comprehensive review of HBOT for ocular indications. The authors recommend the following as ocular indications for HBOT: decompression sickness or arterial gas embolism with visual signs or symptoms, central retinal artery occlusion, ocular and periocular gas gangrene, cerebro-rhino-orbital mucormycosis, periocular necrotizing fasciitis, carbon monoxide poisoning with visual sequelae, radiation optic neuropathy, radiation or mitomycin C-induced scleral necrosis, and periorbital reconstructive surgery. Other ocular disorders that may benefit from HBOT include selected cases of ischemic optic neuropathy, ischemic central retinal vein occlusion, branch retinal artery occlusion with central vision loss, ischemic branch retinal vein occlusion, cystoid macular edema associated with retinal venous occlusion, post-surgical inflammation, or intrinsic inflammatory disorders, periocular brown recluse spider envenomation, ocular quinine toxicity, Purtscher's retinopathy, radiation retinopathy, anterior segment ischemia, retinal detachment in sickle cell disease, refractory actinomycotiC lacrimal canaliculitis, pyoderma gangrenosum of the orbit and refractory pseudomonas keratitis. Visual function should be monitored as clinically indicated before, during, and after therapy when HBOT is undertaken to treat vision loss. Visual acuity alone is not an adequate measure of visual function to monitor the efficacy of HBOT in this setting. Ocular examinations should also include automated perimetry to evaluate the central 30 degrees of visual field at appropriate intervals. Interpretation of the literature on the efficacy of HBOT in treating ocular disorders is complicated by several factors: frequent failure to include visual field examination as an outcome measure, failure to adequately address the interval from symptom onset to initiation of HBOT, and lack of evidence for optimal treatment regimens for essentially all ocular indications. Because some ocular disorders require rapid administration of HBOT to restore vision, patients with acute vision loss should be considered emergent when they present.
Conclusion: Visual acuity should be checked immediately, including vision with pinhole correction. If the patient meets the criteria for emergent HBOT outlined in the paper, normobaric oxygen should be started at the highest inspired oxygen fraction possible until arrangements can be made for HBOT.
Article – 10 - Central retinal artery occlusion
Title: Hyperbaric oxygen, oxygen-ozone therapy, and rheologic parameters of blood in patients with peripheral occlusive arterial disease.
Authors: Verrazzo, G; Coppola, L; Luongo, C; Sammartino, A; Giunta, R; Grassia, A; Ragone, R; Tirelli, A
Digital Object Identifier (or PMID etc): PMID: 7742706
Keywords: Nil
Abstract: For many years, clinical practice has consolidated the use of both hyperbaric oxygen and oxygen-ozone therapy in the treatment of peripheral occlusive arterial disease (POAD). We investigated the influence of these treatments on hemorrheologic parameters that play an important role in the pathogenesis and the clinical course of arteriosclerosis. Two groups of 15 patients suffering from POAD, assigned at random either to a cycle of HBO therapy or O2-O3 therapy, were evaluated for blood viscosity, erythrocyte filterability, hematocrit value, fibrinogen concentration, and thrombin time. The O2-O3 therapy caused a significant increase of erythrocyte filterability and a significant decrease of blood viscosity. By contrast, HBO therapy did not produce any significant change.
Conclusion: The increase of lipid peri-oxidation, proved by raised malonyldialdehyde plasma levels, seems a likely mechanism involved in the hemorrheologic effects of O2-O3 therapy.
Article – 11 - Central retinal artery occlusion
Title: [abstract] HYPERBARIC OXYGEN TREATMENT OF RETINAL ARTERY OCCLUSION
Authors: Weiss, J
Digital Object Identifier (or PMID etc): Nil
Keywords: Nil
Abstract: Retinal artery occlusion (RAO) is a common retinal-vascular disorder frequently producing visual loss. Central retinal artery occlusion (CRAO) accounts for approximately 57% of occlusions, branch retinal artery occlusion (BRAO) approximately 38% of occlusions, and cilioretinal artery occlusion for 5%. Hyperoxia can restore retinal oxygen after arterial occlusion, but the inclusion of the different types and etiology of arterial occlusion has resulted in controversy and confusion regarding the use of this therapy. Following ophthalmic and medical evaluation, 5 patients with a 1 to 12 day history of symptoms secondary to RAO and 4 patients with a 1 to 3 week history of CRAO were treated with HBOT. This study systematically characterizes the different clinical entities with respect to HBOT treatment and prognosis.
Results: The 4 patients with BRAO and 1 patient with a cilioretinal artery occlusion improved following HBOT. The 2 patients with a 1 day history of nonarteritic CRAO improved following treatment. The third patient with a 10 day history of nonarteritic CRAO did not improve. Patient #4, with a 3 week history of arteritic CRAO in one eye and a 3 day history in the other eye did not improve. There were no complications. Mechanisms of action are proposed.
Conclusion: HBOT may be a safe and effective treatment in selected patients with longer standing nonarteritic retinal artery occlusions.
Article – 12 - Central retinal artery occlusion
Title: [abstract] HYPERBARIC OXYGEN AS ADJUNCTIVE THERAPY IN THE TREATMENT OF CENTRAL RETINAL ARTERY OCCLUSION.
Authors: Stegmann, BJ; Hart, GB; Strauss, MB
Digital Object Identifier (or PMID etc): Nil
Keywords: Nil
Abstract: Hyperbaric oxygen was used to treat six patients, 4 females, 2 males, average age 71 years ± 19 with acute onset of central retinal artery occlusion. Monoplace chambers were used to deliver the following protocol: 2 ATA twenty minutes oxygen breathing with five minute air breaks for a total of 120 minutes. All patients reported visual improvement in a temporal relationship to receiving HBO, with three patients responding to HBO after conventional therapies failed. Responses ranged from the return of light perception to the restoration of baseline vision. Two patients had a repeat episode of blindness after discontinuing HBO and both responded to its reinstitution.
Conclusion: HBO shows potential as a valuable adjunct in the treatment of central retinal artery occlusion.
Article – 13 - Central retinal artery occlusion
Title: [abstract] EFFECT OF HYPERBARIC OXYGEN THERAPY ON CENTRAL RETINAL ARTERY OCCLUSION ASSOCIATED WITH SYSTEMIC LUPUS ERYTHEMATOSUS (A CASE REPORT).
Authors: Cho, S; Choi, MS; Lee, JY; Choi, SJ; Park, YS; Shin, HT
Digital Object Identifier (or PMID etc): Nil
Keywords: Nil
Abstract: Central retinal artery occlusion (CRAO), a rare complication of systemic lupus erythematosus (SLE), is a serious condition because it might cause blindness. Recently there are increasing numbers of reports that the hyperbaric oxygen (HBO) therapy is effective on the CRAO, especially in the early stage. A 42 year-old female patient came to us due to sudden onset of blindness since 15 days prior to visit. Fundoscopy showed findings suggestive of CRAO, and she was diagnosed as SLE because of positive fluorescent antinuclear antibody, pancytopenia, transient psychotic behavior, and negative cerebral angiography and temporal artery biopsy. We applied HBO therapy in a multiplace chamber for a total of 50 days in combination with steroid therapy.
Conclusion: We observed significant improvement of visual acuity. that is, from the hand motion to 0.02.