PMID- 29241233
OWN - NLM
STAT- MEDLINE
DCOM- 20180201
LR  - 20200225
IS  - 1833-3516 (Print)
IS  - 2209-1491 (Electronic)
IS  - 1833-3516 (Linking)
VI  - 47
IP  - 4
DP  - 2017 Dec
TI  - Hyperbaric oxygen in the treatment of acute retinal artery occlusion.
PG  - 233-238
LID - 10.28920/dhm47.4.233-238 [doi]
AB  - INTRODUCTION: Acute retinal artery occlusion (ARAO) is a major cause of sudden, 
      painless visual loss, often leaving no useful vision in the affected eye. Its 
      incidence is cited at 0.85 per 100,000 persons per year but may be higher because 
      of under-reporting. The natural history is difficult to study, but a spontaneous 
      resolution rate of < 1-8% for acute, non-arteritic ARAO has been cited. 
      Occurrence in an only eye is devastating for the patient. There is currently no 
      consensus regarding management of ARAO and little evidence to support any 
      treatment modality. Despite only limited case series, hyperbaric oxygen treatment 
      (HBOT) is recommended for ARAO by the Undersea and Hyperbaric Medical Society 
      (UHMS) and by the European Committee for Hyperbaric Medicine. METHODS: Between 
      early 2003 and December 2012, all ARAO patients presenting to Christchurch 
      Hospital were referred for consideration of HBOT. These 31 consecutive patients' 
      medical records were reviewed retrospectively. The time delay from onset of 
      visual loss to commencing HBOT; the presenting visual acuity; various demographic 
      data; the HBOT administered and the outcome visual acuity were documented. 
      RESULTS: All 31 patients underwent at least one HBOT (median 4, range 1-7) at a 
      pressure of 203-284 kPa for 1.5 to 2.0 h. One patient's treatment was terminated 
      after 60 min at their request; another declined further HBOT and one suffered 
      middle ear barotrauma. Thirteen patients also received anticoagulants at the 
      discretion of the referring ophthalmologist. Twenty three patients had 
      temporarily improved vision with the first HBOT. Seven patients had permanent, 
      good visual recovery (6/18 or better; Snellen chart); and two only modest 
      improvement (6/60). All nine patients who improved permanently were treated 
      within 10 hours of symptom onset. CONCLUSIONS: Where available, HBOT is indicated 
      for ARAO. Our protocol may not have been aggressive enough and the UHMS protocol 
      is recommended. A multi-centre, randomised controlled trial is feasible, but 
      would be logistically difficult and expensive and may be ethically unsupportable 
      given the lack of alternative, effective treatments.
CI  - Copyright: This article is the copyright of the authors who grant Diving and 
      Hyperbaric Medicine a non-exclusive licence to publish the article in printed and 
      other forms.
FAU - Elder, Mark J
AU  - Elder MJ
AD  - Ophthalmology Department, Christchurch Hospital, Private Bag 4710, Christchurch 
      8140, New Zealand, mark.elder@cdhb.health.nz.
AD  - University of Otago, Christchurch.
FAU - Rawstron, John A
AU  - Rawstron JA
AD  - Ophthalmology Department, Christchurch Hospital, Christchurch, New Zealand.
FAU - Davis, Michael
AU  - Davis M
AD  - University of Otago, Christchurch.
AD  - formerly Hyperbaric Medicine Unit, Christchurch Hospital.
LA  - eng
PT  - Journal Article
PL  - Australia
TA  - Diving Hyperb Med
JT  - Diving and hyperbaric medicine
JID - 101282742
SB  - IM
MH  - Acute Disease
MH  - Adult
MH  - Aged
MH  - Aged, 80 and over
MH  - Female
MH  - Humans
MH  - Hyperbaric Oxygenation/*methods/statistics & numerical data
MH  - Male
MH  - Middle Aged
MH  - Ocular Hypertension/therapy
MH  - Retinal Artery Occlusion/complications/*therapy
MH  - Retrospective Studies
MH  - Treatment Outcome
MH  - Vision Disorders/etiology/*therapy
PMC - PMC6706338
OTO - NOTNLM
OT  - Clinical audit
OT  - Outcome
OT  - Retrospective studies
OT  - Vision disorders
OT  - Visual acuity
COIS- Conflict of interest and funding: nil.
EDAT- 2017/12/15 06:00
MHDA- 2018/02/02 06:00
PMCR- 2018/12/31
CRDT- 2017/12/15 06:00
PHST- 2017/09/02 00:00 [received]
PHST- 2017/09/21 00:00 [accepted]
PHST- 2017/12/15 06:00 [entrez]
PHST- 2017/12/15 06:00 [pubmed]
PHST- 2018/02/02 06:00 [medline]
PHST- 2018/12/31 00:00 [pmc-release]
AID - 10.28920/dhm47.4.233-238 [doi]
PST - ppublish
SO  - Diving Hyperb Med. 2017 Dec;47(4):233-238. doi: 10.28920/dhm47.4.233-238.