Management of central retinal artery occlusion following successful hyperbaric oxygen therapy: case report

Abstract

This case report presents a patient with central retinal artery occlusion (CRAO) who was successfully treated with hyperbaric oxygen (HBO₂) but subsequently suffered a recurrence of his visual loss. CRAO may be treated successfully with HBO₂ if treatment is undertaken promptly after the onset of vision loss. The goal of HBO₂ therapy is to oxygenate the ischemic inner retinal layers via diffusion from the hyperoxygenated choroidal circulation until recanalization of the central retinal artery occurs. A 71-year-old man presented with hand motion vision and fundus findings of CRAO in his left eye. Treatment with HBO₂ was initiated approximately 9.5 hours after loss of vision. The patient experienced return of vision to a near-normal level during HBO₂. His vision loss recurred, however, 15 minutes after the HBO₂ session. There was a delay to follow-up HBO₂ treatments, and the improvement of vision that resulted from these subsequent HBO₂ sessions was much less than that experienced during his initial HBO₂ treatment. Recovery of vision during initial HBO₂ treatment indicated that this patient's retina had not yet suffered irreversible ischemic damage at that point in time. CRAO patients with a good result from initial HBO₂ treatment should be admitted to a stroke center and should have their visual status monitored hourly. Should vision loss recur, aggressive use of intermittent 100% normobaric and hyperbaric oxygen is indicated to preserve retinal function until central retinal artery recanalization occurs. An evidence-based management plan for such patients is presented.