Hyperbaric oxygen therapy in branch retinal artery occlusion in a 15-year-old boy with methylenetetrahydrofolate reductase mutation.

Ali Riza Cenk Celebi,Bora Eldem,Sibel Kadayifcilar

doi:10.1155/2015/640247

Abstract

Purpose. To report the efficacy of hyperbaric oxygen (HBO) therapy in a case of branch retinal artery occlusion (BRAO) in a 15-year-old boy. Methods. We report a 15-year-old boy with sudden loss of vision due to BRAO. Examination included laboratory evaluation for systemic risk factors. Follow-up exams included visual acuity, fundus examination, fundus fluorescein angiography, and visual field testing. HBO therapy was employed for treatment. Results. Medical history was positive for isolated glucocorticoid deficiency. Laboratory evaluation disclosed hyperhomocysteinemia and methylenetetrahydrofolate reductase (MTHFR) mutation. The visual acuity 0.05 at presentation improved to 0.8 after 20 days of HBO therapy. There was no change on visual fields. Conclusion. In this pediatric case, HBO therapy was useful in the treatment of BRAO.

Highlights

Retinal artery occlusion (RAO) is a common vision-threatening disease affecting primarily patients older than 60 years
Increased serum homocysteine has been indicated as a risk factor in retinal vascular occlusive disease [1]
Weger and associates found the relationship between hyperhomocysteinemia and methylenetetrahydrofolate reductase (MTHFR) mutation in retinal artery occlusion [2]

Summary

Introduction

Retinal artery occlusion (RAO) is a common vision-threatening disease affecting primarily patients older than 60 years. A number of therapies had been used in the treatment of retinal arterial occlusive diseases These included carbogen inhalation, acetazolamide infusion, ocular massage, and paracentesis, as well as vasodilators such as intravenous glyceryl trinitrate [3]. None of these have been shown to alter the natural history of disease definitively. Hyperbaric oxygen (HBO) therapy uses intermittent breathing of 100% oxygen at pressures >1 atmosphere absolute (ATA). HBO increases the amount of oxygen dissolved in plasma, from 0.32 to 6 mL O2/100 mL of blood when breathing 100% O2 at 3 ATA. We hereby report branch retinal artery occlusion (BRAO) associated with MTHFR mutation in a 15-year-old boy treated with HBO

Case Presentation

Findings

Discussion