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Doğruya S, T Altınbay B, Kayıkçıoğlu ÖC, Altınışık M, Kurt E, Kayıkçıoğlu ÖR. Our Results of Hyperbaric Oxygen or Pars Plana Vitrectomy in Central Retinal Artery Obstruction. J INVEST SURG 2025; 38:2503811. [PMID: 40375561 DOI: 10.1080/08941939.2025.2503811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2024] [Accepted: 05/03/2025] [Indexed: 05/18/2025]
Abstract
PURPOSE We aimed to present the results of patients with central retinal artery obstruction (CRAO) who underwent 23-G pars plana vitrectomy (PPV) or hyperbaric oxygen therapy (HBOT) following emergency medical therapy. METHOD The files of 15 patients with acute CRAO were retrospectively reviewed. Comprehensive ophthalmological examinations of the patients were performed. Seven patients received HBOT, and eight patients received PPV following emergency medical treatment. The patient's demographic characteristics, initial and final visual acuity, intraocular pressure were examined. RESULTS The mean age was 65.2 ± 9.9 years in the hyperbaric oxygen therapy group and 58.7 ± 12.8 years in the PPV group. There was no statistically significant difference between the group receiving HBOT and the group undergoing PPV regarding age, initial visual acuity, final visual acuity, visual gain difference between visual acuity improvements, intraocular pressure, and time lag for treatment initiation (p > 0.05). CONCLUSION Although some improvement in visual acuity was observed in both treatment groups - particularly in patients who underwent PPV - this change did not reach statistical significance. Therefore, despite timely intervention, the overall visual outcomes in CRAO remain poor.
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Affiliation(s)
- S Doğruya
- Department of Ophthalmology, Uşak University, Uşak, Turkey
| | | | | | - M Altınışık
- Department of Ophthalmology, Celal Bayar University, Manisa, Turkey
| | - E Kurt
- Department of Ophthalmology, Celal Bayar University, Manisa, Turkey
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Au SCL, Chong SSY. Prognostic factors for acute central retinal artery occlusion treated with hyperbaric oxygen: The Hong Kong study report number five. World J Methodol 2025; 15:96777. [DOI: 10.5662/wjm.v15.i2.96777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2024] [Revised: 10/11/2024] [Accepted: 11/07/2024] [Indexed: 11/27/2024] Open
Abstract
BACKGROUND Central retinal artery occlusion (CRAO) is a potentially blinding disease, and hyperbaric oxygen therapy (HBOT) is becoming increasingly popular with the support of scientific evidence. Despite the presence of various acute management measures, there is no clear evidence on the gold standard treatment for CRAO.
AIM To identify factors and imaging parameters associated with good visual outcome, which guide ophthalmologists in the triage of CRAO patients for HBOT.
METHODS Patients who suffered from CRAO and had a symptom onset ≤ 6 h were recruited for a course of HBOT in a tertiary hospital after failing bedside treatment. Patient demographics, onset time, CRAO eye parameters, and past medical history were prospectively collected. Visual outcomes after HBOT were also analyzed.
RESULTS A total of 26 patients were included; the female-to-male ratio was 1:1.6, and the mean age was 67.5 years ± 13.3 years (range 44–89 years). The mean duration of follow-up and mean visual acuity (VA) improvement were 10.0 mo ± 5.3 mo and 0.48 logarithm of minimal angle of resolution (logMAR) ± 0.57 logMAR (approximately 9 letters in ETDRS) (P = 0.0001, Z = -3.67), respectively. The 1 mm zone of central macular thickness (CMT) on optical coherence tomography was not associated with VA changes (P = 0.119); however, the 1-to-3 mm circular rim of CMT was fairly associated (P = 0.02, Spearman's coefficient = 0.45). Complete retinal perfusion time during fundus fluorescein angiography (FFA) was moderately associated (P = 0.01, Spearman's coefficient = 0.58) with visual outcome.
CONCLUSION A thinner 1-to-3 mm circular rim of CMT, but not the central 1 mm zone, is associated with better visual outcome. A shorter perfusion delay on FFA is also associated with better visual outcome.
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Affiliation(s)
- Sunny Chi Lik Au
- Department of Ophthalmology, Tung Wah Eastern Hospital, Hong Kong 999077, China
- Department of Ophthalmology, Pamela Youde Nethersole Eastern Hospital, Hong Kong 999077, China
| | - Steffi Shing Yee Chong
- Department of Ophthalmology, Tung Wah Eastern Hospital, Hong Kong 999077, China
- Department of Ophthalmology, Pamela Youde Nethersole Eastern Hospital, Hong Kong 999077, China
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Yang CC, Weng CC, Chou YB, Huang YM, Hwang DK, Chen SJ, Lin TC. Visual outcomes of central retinal artery occlusion: Exploring treatment strategies beyond the conventional time window. J Stroke Cerebrovasc Dis 2025; 34:108240. [PMID: 39809373 DOI: 10.1016/j.jstrokecerebrovasdis.2025.108240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2024] [Revised: 11/13/2024] [Accepted: 01/11/2025] [Indexed: 01/16/2025] Open
Abstract
BACKGROUNDS/AIMS Central retinal artery occlusion (CRAO) is a vision-devastating emergency. However, widely-acknowledged treatment consensus is lacking and prehospital delays commonly occur. Hence, we aimed to investigate the visual outcomes of conservative treatments (CT), local intra-arterial fibrinolysis (LIF) and hyperbaric oxygen (HBO) therapy for non-arteritic CRAO (NA-CRAO) patients beyond the conventional time window. METHODS This retrospective comparative study included 99 NA-CRAO patients followed up for over 6 months. The subjects were divided into three groups: the CT (50 patients), LIF (10 patients) and HBO group (39 patients). The primary endpoint was the best-corrected visual acuity (BCVA) change at 6 months compared to baseline. The secondary endpoint was the improvement in BCVA at 1 year and final visits. RESULTS No heterogeneity regarding demographics was identified. However, the HBO group had a more extended time-to-treatment period (median 6.0 days) and more advanced-stage CRAO cases (41 % stage III) than the CT (median 4.0 days, 14 % stage III) and LIF (median 0.6 days, 20 % stage III) groups. Despite this, the HBO group exhibited a significantly greater BCVA and a higher proportion of patients achieving significant vision improvement than those in the CT group at 6-, 12-month and final exams (51.3 % vs. 24.0 %, P < 0.05). The LIF appeared to improve outcomes more than CT over time without significance. CONCLUSION Our study provided a concurrent comparison across 3 approaches and demonstrated that HBO therapy beyond the time window remained more effective in improving vision than CT alone for NA-CRAO patients, which had not been proposed by prior studies.
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Affiliation(s)
- Chi-Chun Yang
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan, Republic of China
| | - Chang-Chi Weng
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan, Republic of China; Department of Ophthalmology, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, Republic of China
| | - Yu-Bai Chou
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan, Republic of China; Department of Ophthalmology, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, Republic of China
| | - Yi-Ming Huang
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan, Republic of China; Department of Ophthalmology, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, Republic of China
| | - De-Kuang Hwang
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan, Republic of China; Department of Ophthalmology, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, Republic of China
| | - Shih-Jen Chen
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan, Republic of China; Department of Ophthalmology, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, Republic of China
| | - Tai-Chi Lin
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan, Republic of China; Department of Ophthalmology, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, Republic of China.
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Tanaka S, Hayakawa M, Tasaki K, Ono R, Hirata K, Hosoo H, Ito Y, Marushima A, Yamagami H, Oshika T, Matsumaru Y. Successful recovery of vision following intravenous thrombolysis using low-dose alteplase in central retinal artery occlusion. Am J Emerg Med 2025; 87:216.e5-216.e9. [PMID: 39542820 DOI: 10.1016/j.ajem.2024.11.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2024] [Accepted: 11/07/2024] [Indexed: 11/17/2024] Open
Abstract
Central retinal artery occlusion (CRAO) is an ophthalmic emergency characterized by sudden loss of vision with a low chance of spontaneous recovery. This case report presents a 49-year-old female with sudden right eye visual loss, diagnosed as non-arteritic CRAO. Fundoscopic examination revealed retinal pallor, and optical coherence tomography demonstrated edema of the inner retinal layer, consistent with CRAO. Brain magnetic resonance imaging (MRI) showed an acute ischemic lesion in the right occipital subcortex. The patient received intravenous recombinant tissue plasminogen activator (IV rt-PA) at a lower-than-standard dose of 0.6 mg/kg within 4 h and 17 min of symptom onset, resulting in significant visual improvement. Extensive etiological investigation, including transesophageal echocardiography, uncovered a large, high-risk patent foramen ovale (PFO), leading to the diagnosis of PFO-associated CRAO and concomitant embolic stroke. This case suggests the effectiveness of low-dose IV rt-PA in treating CRAO, which might offer comparable efficacy to the standard dose while potentially minimizing bleeding risks. It also emphasizes the importance of considering cardiac comorbidities, particularly PFO, in younger CRAO patients, and underscores the need for a multidisciplinary approach and comprehensive stroke-etiology workups in CRAO management. This report contributes to the limited evidence on CRAO treatment in Japan, particularly in the context of lower tPA dosing and associated cardiac abnormalities. It underscores the importance of early diagnosis, treatment, and thorough etiological investigation in improving outcomes for CRAO patients.
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Affiliation(s)
- Shun Tanaka
- Department of Stroke and Cerebrovascular Diseases, University of Tsukuba Hospital, 2-1-1 Amakubo, Tsukuba, Ibaraki 305-8576, Japan
| | - Mikito Hayakawa
- Department of Stroke and Cerebrovascular Diseases, University of Tsukuba Hospital, 2-1-1 Amakubo, Tsukuba, Ibaraki 305-8576, Japan; Department of Neurology, Institute of Medicine, University of Tsukuba, 1-1-1, Tenno-dai, Tsukuba, Ibaraki 305-8575, Japan.
| | - Kuniharu Tasaki
- Department of Ophthalmology, Institute of Medicine, University of Tsukuba, 1-1-1 Tenno-dai, Tsukuba, Ibaraki 305-8575, Japan
| | - Ryohei Ono
- Department of Stroke and Cerebrovascular Diseases, University of Tsukuba Hospital, 2-1-1 Amakubo, Tsukuba, Ibaraki 305-8576, Japan; Department of Neurosurgery, Institute of Medicine, University of Tsukuba, 1-1-1 Tenno-dai, Tsukuba, Ibaraki 305-8575, Japan
| | - Koji Hirata
- Department of Stroke and Cerebrovascular Diseases, University of Tsukuba Hospital, 2-1-1 Amakubo, Tsukuba, Ibaraki 305-8576, Japan; Department of Neurosurgery, Institute of Medicine, University of Tsukuba, 1-1-1 Tenno-dai, Tsukuba, Ibaraki 305-8575, Japan
| | - Hisayuki Hosoo
- Department of Stroke and Cerebrovascular Diseases, University of Tsukuba Hospital, 2-1-1 Amakubo, Tsukuba, Ibaraki 305-8576, Japan; Department of Neurosurgery, Institute of Medicine, University of Tsukuba, 1-1-1 Tenno-dai, Tsukuba, Ibaraki 305-8575, Japan
| | - Yoshiro Ito
- Department of Stroke and Cerebrovascular Diseases, University of Tsukuba Hospital, 2-1-1 Amakubo, Tsukuba, Ibaraki 305-8576, Japan; Department of Neurosurgery, Institute of Medicine, University of Tsukuba, 1-1-1 Tenno-dai, Tsukuba, Ibaraki 305-8575, Japan
| | - Aiki Marushima
- Department of Stroke and Cerebrovascular Diseases, University of Tsukuba Hospital, 2-1-1 Amakubo, Tsukuba, Ibaraki 305-8576, Japan; Department of Neurosurgery, Institute of Medicine, University of Tsukuba, 1-1-1 Tenno-dai, Tsukuba, Ibaraki 305-8575, Japan
| | - Hiroshi Yamagami
- Department of Stroke and Cerebrovascular Diseases, University of Tsukuba Hospital, 2-1-1 Amakubo, Tsukuba, Ibaraki 305-8576, Japan; Division of Stroke Prevention and Treatment, Institute of Medicine, University of Tsukuba, 1-1-1 Tenno-dai, Tsukuba, Ibaraki 305-8575, Japan
| | - Tetsuro Oshika
- Department of Ophthalmology, Institute of Medicine, University of Tsukuba, 1-1-1 Tenno-dai, Tsukuba, Ibaraki 305-8575, Japan
| | - Yuji Matsumaru
- Department of Stroke and Cerebrovascular Diseases, University of Tsukuba Hospital, 2-1-1 Amakubo, Tsukuba, Ibaraki 305-8576, Japan; Department of Neurosurgery, Institute of Medicine, University of Tsukuba, 1-1-1 Tenno-dai, Tsukuba, Ibaraki 305-8575, Japan
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Kim BM, Wang KY, Xu TT, Hooshmand SJ, Toups GN, Millman MP, Steinkraus LW, Tooley AA, Barkmeier AJ, Chen JJ. Outcomes of Hyperbaric Oxygen Treatment for Central Retinal Artery Occlusion: A Single Center Experience. Am J Ophthalmol 2025; 269:393-401. [PMID: 39368618 DOI: 10.1016/j.ajo.2024.09.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2024] [Revised: 09/22/2024] [Accepted: 09/23/2024] [Indexed: 10/07/2024]
Abstract
PURPOSE To describe the outcomes of hyperbaric oxygen therapy (HBOT) for patients with central retinal artery occlusion (CRAO) at a single tertiary care center. DESIGN Retrospective clinical cohort study. METHODS Medical records of all patients diagnosed with CRAO who received HBOT at Mayo Clinic in Rochester, Minnesota from January 1, 2009 to December 31, 2020 were reviewed to confirm diagnosis, time from onset to presentation, exam findings, treatments, and follow-up data. Main outcome measures included final visual acuity (VA) and number of lines of improvement. RESULTS There were 41 patients diagnosed with CRAO who received HBOT during the 12-year study period. Median time from symptom onset to HBOT treatment was 9.5 h (interquartile range [IQR] 6.5, 14.0 h), and patients received a median of 4 HBOT sessions (IQR 2.5, 6.0 sessions). There were 20 patients who received HBOT within 9 h, 14 (70%) of which had clinically meaningful improvement in VA of ≥0.3 logMAR. In comparison, of the 21 patients treated after 9 h, 6 (28.6%) had VA improvement of ≥0.3 logMAR (P = .008). For all patients, the median logMAR VA at presentation was 2.00 (IQR 1.70, 2.30) and the median logMAR VA at follow-up was 1.94 (IQR 1.00, 2.00) (P < .001), with median lines of improvement of 3.0 (IQR 0.0, 7.0). For patients treated within 9 h, the median logMAR VA at presentation was 2.00 (IQR 1.93, 2.30) and the median logMAR VA at follow-up was 1.70 (IQR 0.54, 2.00). Patients treated within 9 h had statistically significant greater median lines of VA improvement than cases that were treated after >9 h from symptom onset at 5.9 (IQR 3.0, 10.0) and 0.0 (IQR 0.0, 3.0), respectively (P < .001). There was no difference in VA recovery associated with specific retinal exam findings such as cherry-red spot (P = .22) and cilioretinal artery perfusion (P = .36) compared to patients without those findings. CONCLUSION There was a statistically significant improvement in VA after HBOT treatment in CRAO patients among patients that received early HBOT, with patients receiving the most benefit when receiving treatment within 9 h. Randomized control trials in patients with CRAO are required to confirm the efficacy of HBOT.
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Affiliation(s)
- Boyoung M Kim
- From the Alix School of Medicine, Mayo Clinic (B.M.K., K.Y.W.), Rochester, Minnesota, USA
| | - Kenny Y Wang
- From the Alix School of Medicine, Mayo Clinic (B.M.K., K.Y.W.), Rochester, Minnesota, USA
| | - Timothy T Xu
- Department of Ophthalmology, Mayo Clinic (T.T.X., A.A.T., A.J.B., J.J.C.), Rochester, Minnesota, USA
| | - Sara J Hooshmand
- Department of Neurology, Mayo Clinic (S.J.H., J.J.C.), Rochester, Minnesota, USA
| | - Gary N Toups
- Department of Aerospace Medicine, Mayo Clinic (G.N.T.), Rochester, Minnesota, USA
| | - Martha P Millman
- Department of Internal Medicine, Mayo Clinic (M.P.M., L.W.S.), Rochester, Minnesota, USA
| | - Lawrence W Steinkraus
- Department of Internal Medicine, Mayo Clinic (M.P.M., L.W.S.), Rochester, Minnesota, USA
| | - Andrea A Tooley
- Department of Ophthalmology, Mayo Clinic (T.T.X., A.A.T., A.J.B., J.J.C.), Rochester, Minnesota, USA
| | - Andrew J Barkmeier
- Department of Ophthalmology, Mayo Clinic (T.T.X., A.A.T., A.J.B., J.J.C.), Rochester, Minnesota, USA
| | - John J Chen
- Department of Ophthalmology, Mayo Clinic (T.T.X., A.A.T., A.J.B., J.J.C.), Rochester, Minnesota, USA; Department of Neurology, Mayo Clinic (S.J.H., J.J.C.), Rochester, Minnesota, USA.
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Cetinoglu I, Unlu MT, Sit HY, Aygun N, Tiryaki Demir S, Uludag M. A unique complication of thyroidectomy for Hashimoto's thyroiditis: central retinal artery thrombosis. Acta Chir Belg 2024; 124:409-414. [PMID: 38391299 DOI: 10.1080/00015458.2024.2323286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 02/22/2024] [Indexed: 02/24/2024]
Abstract
BACKGROUND Central retinal artery occlusion (CRAO) is a rare ophthalmological emergency and also a unique complication after thyroid surgery. METHODS We present the first case of CRAO following thyroid surgery in a patient with Hashimoto's thyroiditis, along with a variety of interventions to overcome this complication. RESULTS A 42-year-old female patient suffering from sudden vision loss following total thyroidectomy was diagnosed with CRAO. Hyperbaric oxygen therapy was started within the postoperative first 6 hours. CONCLUSION Although it is extremely rare, it should be noted that patients may experience retinal artery occlusion following the thyroid surgery. Immediate evaluation of patients with visual impairment in the early postoperative period, and planning of emergent hyperbaric oxygen therapy for the management are critical.
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Affiliation(s)
- Isik Cetinoglu
- Department of General Surgery, Sisli Hamidiye Etfal Training and Research Hospital, University of Health Sciences Turkey, Istanbul, Turkey
| | - Mehmet Taner Unlu
- Department of General Surgery, Sisli Hamidiye Etfal Training and Research Hospital, University of Health Sciences Turkey, Istanbul, Turkey
| | - Hatice Yasemin Sit
- Department of Ophthalmology, Sisli Hamidiye Etfal Training and Research Hospital, University of Health Sciences Turkey, Istanbul, Turkey
| | - Nurcihan Aygun
- Department of General Surgery, Sisli Hamidiye Etfal Training and Research Hospital, University of Health Sciences Turkey, Istanbul, Turkey
| | - Semra Tiryaki Demir
- Department of Ophthalmology, Sisli Hamidiye Etfal Training and Research Hospital, University of Health Sciences Turkey, Istanbul, Turkey
| | - Mehmet Uludag
- Department of General Surgery, Sisli Hamidiye Etfal Training and Research Hospital, University of Health Sciences Turkey, Istanbul, Turkey
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Chen C, Singh G, Madike R, Cugati S. Central retinal artery occlusion: a stroke of the eye. Eye (Lond) 2024; 38:2319-2326. [PMID: 38548943 PMCID: PMC11306586 DOI: 10.1038/s41433-024-03029-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 02/13/2024] [Accepted: 03/08/2024] [Indexed: 08/09/2024] Open
Abstract
Central retinal artery occlusion (CRAO), like a stroke in the brain, is a critical eye condition that requiring urgent medical attention. Patients with CRAO present with acute loss of vision and the visual prognosis is poor with low chance of spontaneous visual recovery. Moreover, the risk of developing ischaemic heart disease and cerebral stroke is increased due to the presence of underlying atherosclerotic risk factors. Currently, there is no officially recommended treatment for CRAO. This review will describe the anatomy, pathophysiology, clinical features of CRAO, as well as exploring existing and potential future approaches for managing the condition.
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Affiliation(s)
- Celia Chen
- Department of Ophthalmology, Flinders Medical Centre and Flinders University, Adelaide, South Australia, Australia.
| | - Gurfarmaan Singh
- The University of Adelaide School of Medicine, Adelaide, South Australia, Australia
- Department of Ophthalmology, Modbury Hospital, Adelaide, South Australia, Australia
| | - Reema Madike
- The University of Adelaide School of Medicine, Adelaide, South Australia, Australia
| | - Sudha Cugati
- The University of Adelaide School of Medicine, Adelaide, South Australia, Australia
- Department of Ophthalmology, Modbury Hospital, Adelaide, South Australia, Australia
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Maldonado F, Reis da Silva A, A Ramos R, Gaio-Lima C, Castro A, Ferreira AP, Camacho Ó, Teixeira C. Effects of Hyperbaric Oxygen Therapy in the Treatment of Patients With Central Retinal Artery Occlusion: A Retrospective Study. Cureus 2024; 16:e66196. [PMID: 39113814 PMCID: PMC11304401 DOI: 10.7759/cureus.66196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/05/2024] [Indexed: 08/10/2024] Open
Abstract
Background Central retinal artery occlusion (CRAO) results in sudden, painless vision loss. As an analogous condition to acute ischemic stroke, CRAO is an ophthalmological emergency, but a standardized treatment is lacking. Hyperbaric oxygen therapy (HBOT) has been widely used in spite of the inconsistent results reported. Purpose To report the visual acuity (VA) outcomes in all patients submitted to HBOT with non-arteritic CRAO in a tertiary center. Methods This retrospective study included all adult patients with CRAO and symptoms lasting for less than 24 hours who were prescribed HBOT in the Hyperbaric Medicine Unit of a Portuguese hospital from March 2009 to February 2023. Patient demographic information, medical history, ophthalmologic evaluation, hospital of referral, time until HBOT, supplementary treatments, number of HBOT sessions, adverse effects, and patient subjective VA gain were collected. All patients were subjected to 90-minute HBOT sessions with 100% oxygen at 2.4 ATA. The primary outcome was VA change (dif-logMAR) before and after treatment. A clinically significant visual improvement was defined as a dif-logMAR≥0.3. Data were analyzed using IBM SPSS Statistics for Windows, Version 29 (Released 2021; IBM Corp., Armonk, New York, United States) (p<0.05 is considered significant). Results A total of 114 patients were included in this study; 68% (n=77) were male, with a mean age of 69 years, and were subjected to a median number of seven HBOT sessions. No serious adverse effects from HBOT were reported. The mean time delay from symptoms to treatment was 12 hours, and best-corrected visual acuity (BCVA) at baseline was counting fingers or worse in 84% (n=96) of the patients. A dif-logMAR≥0.3 occurred in 46% (n=52) of the patients, and 58% (n=66) reported subjective VA improvement after the treatment. A significant improvement between BCVA before HBOT (2.12±0.74) and after HBOT (1.67±0.74) was observed. The VA outcome was found to be related to the total number of sessions, age, obesity, supplementary treatments, and cherry-red spot (CRS) at presentation. There were no significant effects of the time delay from symptoms to treatment in the explanation of the VA outcome. Conclusions HBOT appears to be safe and has a beneficial effect on VA outcomes in patients with non-arteritic CRAO, particularly depending on the number of sessions. Patient factors such as age, obesity, and the presence of CRSs also appear to influence the VA outcome.
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Affiliation(s)
- Filipa Maldonado
- Department of Anesthesiology, Unidade Local de Saúde de Matosinhos - Hospital Pedro Hispano, Matosinhos, PRT
| | - Alexandre Reis da Silva
- Department of Ophthalmology, Unidade Local de Saúde de Matosinhos - Hospital Pedro Hispano, Matosinhos, PRT
| | - Rui A Ramos
- Department of Anesthesiology, Unidade Local de Saúde de Matosinhos - Hospital Pedro Hispano, Matosinhos, PRT
| | - Clara Gaio-Lima
- Department of Hyperbaric Medicine, Unidade Local de Saúde de Matosinhos - Hospital Pedro Hispano, Matosinhos, PRT
- Department of Anesthesiology, Unidade Local de Saúde de Matosinhos - Hospital Pedro Hispano, Matosinhos, PRT
| | - Ana Castro
- Department of Anesthesiology, Unidade Local de Saúde de Matosinhos - Hospital Pedro Hispano, Matosinhos, PRT
| | - António Pedro Ferreira
- Department of Hyperbaric Medicine, Unidade Local de Saúde de Matosinhos - Hospital Pedro Hispano, Matosinhos, PRT
- Department of Anesthesiology, Unidade Local de Saúde de Matosinhos - Hospital Pedro Hispano, Matosinhos, PRT
| | - Óscar Camacho
- Department of Hyperbaric Medicine, Unidade Local de Saúde de Matosinhos - Hospital Pedro Hispano, Matosinhos, PRT
- Department of Anesthesiology, Unidade Local de Saúde de Matosinhos - Hospital Pedro Hispano, Matosinhos, PRT
| | - Carla Teixeira
- Department of Ophthalmology, Unidade Local de Saúde de Matosinhos - Hospital Pedro Hispano, Matosinhos, PRT
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Emmerton W, Banham ND, Gawthrope IC. Survey comparing the treatment of central retinal artery occlusion with hyperbaric oxygen in Australia and New Zealand with the recommended guidelines as outlined by the Undersea and Hyperbaric Medical Society. Diving Hyperb Med 2024; 54:97-104. [PMID: 38870951 PMCID: PMC11446600 DOI: 10.28920/dhm54.2.97-104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Accepted: 04/19/2024] [Indexed: 06/15/2024]
Abstract
Introduction Central retinal artery occlusion (CRAO) presents suddenly causing painless loss of vision that is often significant. Meaningful improvement in vision occurs in only 8% of patients with spontaneous reperfusion. Hyperbaric oxygen treatment (HBOT) is considered to be of benefit if commenced before retinal infarction occurs. The Undersea and Hyperbaric Medical Society (UHMS) guidelines on the management of CRAO were last amended in 2019. This survey questioned Australian and New Zealand (ANZ) hyperbaric medicine units (HMUs) about the incidence of CRAO cases referred and compared their subsequent management against the UHMS guidelines. Methods An anonymous survey via SurveyMonkey® was sent to all 12 ANZ HMUs that treat emergency indications, allowing for multiple choice and free text answers regarding their management of CRAO. Results One-hundred and forty-six cases of CRAO were treated in ANZ HMUs over the last five years. Most (101/146) cases (69%) were initially treated at a pressure of 284 kPa. This was the area of greatest difference noted in CRAO management between the UHMS guidelines and ANZ practice. Conclusions Few ANZ HMUs strictly followed the UHMS guidelines. We suggest a more simplified management protocol as used by the majority of ANZ HMUs.
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Affiliation(s)
- William Emmerton
- Department of Anaesthesia and Hyperbaric Medicine, Royal Adelaide Hospital, Adelaide, Australia
- Corresponding author: Dr William Emmerton, Department of Anaesthesia and Hyperbaric Medicine, Royal Adelaide Hospital, Port Road, Adelaide, SA 5000, Australia ORCiD: 0009-0007-0996-0728,
| | - Neil D Banham
- Department of Hyperbaric Medicine, Fiona Stanley Hospital, Perth, Australia
| | - Ian C Gawthrope
- Department of Hyperbaric Medicine, Fiona Stanley Hospital, Perth, Australia
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Chiabo J, Kauert A, Casolla B, Contenti J, Nahon-Esteve S, Baillif S, Arnaud M. Efficacy and safety of hyperbaric oxygen therapy monitored by fluorescein angiography in patients with retinal artery occlusion. Br J Ophthalmol 2024; 108:956-962. [PMID: 37722767 PMCID: PMC11228221 DOI: 10.1136/bjo-2023-323972] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 08/17/2023] [Indexed: 09/20/2023]
Abstract
AIMS To assess the efficacy and safety of a standardised hyperbaric oxygen therapy protocol (HBOT) monitored by fluorescein angiography (FA) in patients with retinal artery occlusion (RAO). METHODS It is a prospective, non-comparative, monocentric study conducted between July 2016 and March 2022. All consecutive patients diagnosed with RAO within 7 days underwent visual acuity measurement, FA, macular optical coherence tomography (OCT) and OCT-angiography. They received two daily HBOT sessions (2.5 atmosphere absolute, 90 min) until revascularisation assessed by FA. Complete ophthalmic follow-up was scheduled at day 14, day 21 and at 1 month. The main outcome measure was a best-corrected visual acuity (BCVA) improvement defined as a decrease ≥0.3 logMAR at 1 month. RESULTS Thirty-one patients were included and received a mean number of 33.9 (13-56) HBOT sessions. Retinal revascularisation was observed in 48.4% and 87.1% of patients at days 14 and 21, respectively. The mean BCVA on referral and at 1 month was 1.51 logMAR and 1.10 logMAR, respectively. Fifteen (48.4%) patients achieved the main outcome measure. Six (19.4%) patients experienced minor barotrauma that did not require HBOT discontinuation. The univariate analysis showed that antiplatelet-treated patients (p=0.044) and patients with a poor initial BCVA (p=0.008) were more likely to achieve a BCVA improvement. OCT-angiography was not sensitive enough to diagnose RAO or assess revascularisation. CONCLUSION In RAO patients monitored by FA until spontaneous revascularisation of the central retinal artery, HBOT was effective and safe.
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Affiliation(s)
- Jeremy Chiabo
- Ophthalmology, Centre Hospitalier Universitaire de Nice, Hôpital Pasteur 2, Nice, France
| | - Andreas Kauert
- Hyperbaric Oxygen Therapy, Pasteur 2 University Hospital, Nice, France
| | - Barbara Casolla
- Stroke Unit neurology, Centre Hospitalier Universitaire de Nice Hôpital Pasteur, Nice, France
| | - Julie Contenti
- Emergency medicine, Centre Hospitalier Universitaire de Nice, Nice, France
| | - Sacha Nahon-Esteve
- Ophthalmology, Centre Hospitalier Universitaire de Nice, Hôpital Pasteur 2, Nice, France
| | - Stephanie Baillif
- Ophthalmology, Centre Hospitalier Universitaire de Nice, Hôpital Pasteur 2, Nice, France
| | - Martel Arnaud
- Ophthalmology, Centre Hospitalier Universitaire de Nice, Hôpital Pasteur 2, Nice, France
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11
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Friedman R, Coombs AV, Stevens S, Lisman RD, Chiu ES. Complete Vision Recovery After Filler-Induced Blindness Using Hyperbaric Oxygen Therapy: Case Report and Literature Review. Aesthet Surg J Open Forum 2024; 6:ojae036. [PMID: 38863892 PMCID: PMC11166482 DOI: 10.1093/asjof/ojae036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2024] Open
Abstract
Injecting soft-tissue fillers, such as hyaluronic acid, has become an extremely popular method of facial augmentation. Although rare, adverse effects, ranging from cosmetically dissatisfactory to dangerous, may occur. The most severe adverse effect of these is vascular occlusion of the central retinal artery, resulting in vision loss. Protocols for the treatment of filler-induced blindness have not been well established, but there is evidence to suggest that hyperbaric oxygen therapy (HBOT) may aid in the therapeutic algorithm for filler-induced blindness. We present a clinical case of filler-induced blindness successfully treated with prompt administration of HBOT. A 38-year-old healthy female presented to the emergency room after immediate pain and complete vision loss following an at-home injection of mail-order filler into the left glabella and medial eyebrow. After treatment with hyaluronidase and ocular massage, neither of which relieved her symptoms, she received HBOT within 10 h of the injury, after which her vision improved significantly. After 2 additional sessions, the patient had complete vision recovery. This case report contributes to the very sparse literature documenting successful treatment of filler-induced blindness using HBOT, advocating for further study, and possible incorporation into the treatment algorithm for filler-induced blindness. Improper soft-tissue filler administration possesses a potential risk of severe adverse effects. It is crucial that the medical community is aware of treatments that offer the highest chance of visual recovery and sustained benefit for patients. Level of Evidence 5
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Affiliation(s)
- Rebecca Friedman
- Corresponding Author: Ms Rebecca Friedman, 307 E 33rd St, New York, NY 10016, USA. E-mail:
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12
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Bastelica P, Florentin G, Baudouin C, Labbé A. [Hyperbaric oxygen therapy and eye disease: Review of the literature]. J Fr Ophtalmol 2024; 47:104107. [PMID: 38430627 DOI: 10.1016/j.jfo.2024.104107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Accepted: 09/28/2023] [Indexed: 03/05/2024]
Abstract
Hyperbaric oxygen therapy consists of breathing 100% oxygen continuously or intermittently in a chamber at a pressure equal to or greater than 1.4 absolute atmospheres. Indicated for the emergency treatment of carbon monoxide poisoning and other medical-surgical pathologies such as gas embolism or necrotizing soft-tissue infections, various studies have shown a beneficial effect of hyperbaric oxygen therapy in certain ocular pathologies, notably of microcirculatory origin, such as central retinal artery occlusion or macular edema linked to retinal vein occlusions. In addition, hyperbaric oxygen might represent an alternative treatment for ocular quinine toxicity and might also be useful as an adjuvant to surgery and antibiotics in cases of periorbital necrotizing fasciitis. On the other hand, oxygen in high concentrations has toxic ocular effects due to the production of reactive oxygen derivatives.
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Affiliation(s)
- P Bastelica
- IHU FOReSIGHT, Service 3, hôpital national de la vision des Quinze-Vingts, 28, rue de Charenton, 75012 Paris 11, France; Institut de la vision, IHU FOReSIGHT, Sorbonne université, 17, rue Moreau, 75012 Paris, France.
| | - G Florentin
- Hôpital Ambroise-Paré, AP-HP, université de Versailles Saint-Quentin en Yvelines, 9, avenue Charles-De-Gaulle, 92100 Boulogne-Billancourt, France
| | - C Baudouin
- IHU FOReSIGHT, Service 3, hôpital national de la vision des Quinze-Vingts, 28, rue de Charenton, 75012 Paris 11, France; Institut de la vision, IHU FOReSIGHT, Sorbonne université, 17, rue Moreau, 75012 Paris, France; Hôpital Ambroise-Paré, AP-HP, université de Versailles Saint-Quentin en Yvelines, 9, avenue Charles-De-Gaulle, 92100 Boulogne-Billancourt, France
| | - A Labbé
- IHU FOReSIGHT, Service 3, hôpital national de la vision des Quinze-Vingts, 28, rue de Charenton, 75012 Paris 11, France; Institut de la vision, IHU FOReSIGHT, Sorbonne université, 17, rue Moreau, 75012 Paris, France; Hôpital Ambroise-Paré, AP-HP, université de Versailles Saint-Quentin en Yvelines, 9, avenue Charles-De-Gaulle, 92100 Boulogne-Billancourt, France
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13
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Gnanasambandam B, Prince J, Limaye S, Moran E, Lee B, Huynh J, Irudayaraj J, Tsipursky M. Addressing retinal hypoxia: pathophysiology, therapeutic innovations, and future prospects. Ther Adv Ophthalmol 2024; 16:25158414241280187. [PMID: 39376745 PMCID: PMC11457288 DOI: 10.1177/25158414241280187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Accepted: 07/30/2024] [Indexed: 10/09/2024] Open
Abstract
Retinal hypoxia stands as a pivotal yet often underappreciated factor in the etiology and progression of many retinal disorders such as glaucoma, hypertensive retinopathy, diabetic retinopathy, retinal vein occlusions, and retinal artery occlusions. Current treatment methodologies fail to directly address the underlying pathophysiology of hypoxia and aim to improve ischemia through alternative methods. In this review, we discuss the critical role of retinal hypoxia in the pathogenesis of various retinal diseases and highlight the need for innovative therapeutic strategies that address the root cause of these conditions. As our understanding of retinal hypoxia continues to evolve, the emergence of new technologies holds the promise of more effective treatments, offering hope to patients at risk of vision loss.
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Affiliation(s)
- Bhargavee Gnanasambandam
- Carle Illinois College of Medicine, University of Illinois at Urbana-Champaign, 506 South Mathews Ave Urbana, Urbana, IL 61801, USA
| | - Jacob Prince
- Carle Illinois College of Medicine, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Siddharth Limaye
- Carle Illinois College of Medicine, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Eric Moran
- Carle Illinois College of Medicine, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Ben Lee
- Carle Illinois College of Medicine, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Justin Huynh
- Carle Illinois College of Medicine, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Joseph Irudayaraj
- Carle Illinois College of Medicine, University of Illinois at Urbana-Champaign, Urbana, IL, USA
- Revive Biotechnology, Inc., Champaign, IL, USA
| | - Michael Tsipursky
- Carle Illinois College of Medicine, University of Illinois at Urbana-Champaign, Urbana, IL, USA
- Revive Biotechnology, Inc., Champaign, IL, USA
- Department of Ophthalmology, Carle Foundation Hospital, Urbana, IL, USA
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14
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Guymer C, Jahan S, Bahrami B, Sia D, Tan BQ, McDonald S, Simon S. Calciphylaxis, beware the ophthalmic mimic: A case series. Clin Nephrol Case Stud 2023; 11:136-146. [PMID: 38169875 PMCID: PMC10759205 DOI: 10.5414/cncs111088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 04/25/2023] [Indexed: 01/05/2024] Open
Abstract
PURPOSE We present two atypical cases of calciphylaxis presenting with ocular ischemic pathology - both without the hallmark cutaneous manifestations - to raise awareness of this rare yet highly disabling condition. OBSERVATIONS We report two cases of ophthalmic calciphylaxis presenting as (1) anterior ischemic optic neuropathy (AION) and cilioretinal artery occlusion in a 76-year-old woman with pre-dialysis kidney failure, and (2) AION with contralateral central retinal artery occlusion (CRAO) in a 44-year-old man on hemodialysis. CONCLUSION AND IMPORTANCE These cases highlight the need for judicious clinical suspicion of calciphylaxis in patients with kidney failure, presenting with microvascular ischemic ophthalmic pathology such as AION or CRAO. Confirmation with temporal artery biopsy is essential to direct targeted individualized multi-disciplinary treatment of calciphylaxis and avoid unnecessary steroid exposure in cases masquerading as giant cell arteritis (GCA).
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Affiliation(s)
| | - Sadia Jahan
- Central and Northern Adelaide Renal and Transplantation Services, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | | | | | - Bee Qung Tan
- Central and Northern Adelaide Renal and Transplantation Services, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Stephen McDonald
- Central and Northern Adelaide Renal and Transplantation Services, Royal Adelaide Hospital, Adelaide, South Australia, Australia
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15
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Williamson J, Sharma A, Murray-Douglass A, Peters M, Lee L, Webb R, Thistlethwaite K, Moloney TP. Outcomes of hyperbaric oxygen treatment for central and branch retinal artery occlusion at a major Australian referral hospital. Diving Hyperb Med 2023; 53:224-229. [PMID: 37718296 PMCID: PMC10735708 DOI: 10.28920/dhm53.3.224-229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 05/14/2023] [Indexed: 09/19/2023]
Abstract
Introduction This study analysed the treatment outcomes of patients that received hyperbaric oxygen treatment (HBOT) for retinal artery occlusion (RAO) at the Royal Brisbane and Women's Hospital in Brisbane, Australia between 2015 and 2021. Methods Retrospective study from patient records including 22 eyes from 22 patients that received HBOT for either central RAO (17 patients) or branch RAO (five patients). Patients received the Royal Brisbane and Women's Hospital RAO protocol for their HBOT. Analysis included best corrected visual acuity pre- and post-treatment, subjective improvements, side effects and patient risk factors were also recorded. Results Improvement in best corrected visual acuity was LogMAR -0.2 for central RAO on average with 8/17 (47%) experiencing objective improvement, 5/17 (29%) experienced no change and 4/22 (24%) experienced a reduction in best corrected visual acuity. Subjective improvement (colour perception or visual fields) was reported in an additional 4/17 patients, resulting in 12/17 (71%) reporting improvement either in visual acuity or subjectively. There was no improvement in the best corrected visual acuity of any of the five patients suffering from branch RAO. Cardiovascular risk factors present in the cohort included hypertension, hypercholesterolaemia, previous cardiovascular events, cardiac disease and smoking. Limited side effects were experienced by this patient cohort with no recorded irreversible side effects. Conclusions Hyperbaric oxygen treatment appears a safe, beneficial treatment for central RAO. No benefit was demonstrated in branch RAO although numbers were small. Increased awareness of HBOT for RAO resulting in streamlined referrals and transfers and greater uptake of this intervention may further improve patient outcomes.
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Affiliation(s)
- Jeremy Williamson
- Department of Ophthalmology, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Anil Sharma
- Department of Ophthalmology, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | | | - Matthew Peters
- Department of Ophthalmology, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Lawrence Lee
- Department of Ophthalmology, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Robert Webb
- Department of Hyperbaric Medicine, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Kenneth Thistlethwaite
- Department of Hyperbaric Medicine, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Thomas P Moloney
- Department of Ophthalmology, Royal Brisbane and Women's Hospital, Brisbane, Australia
- School of Medicine, University of Queensland, Brisbane, Australia
- Corresponding author: Dr Thomas P Moloney, Department of Ophthalmology, Royal Brisbane and Women's Hospital, Brisbane, Australia,
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16
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Masarwa D, Raskin E, Haas K, Singer R, Hauser D. Central retinal artery occlusion as a presenting symptom in Eales' disease: a case report. J Med Case Rep 2023; 17:309. [PMID: 37408048 DOI: 10.1186/s13256-023-04003-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 05/22/2023] [Indexed: 07/07/2023] Open
Abstract
BACKGROUND Eales' disease is an idiopathic peripheral retinal vasculopathy characterized by retinal phlebitis, ischemia, retinal neovascularization, and recurrent vitreous hemorrhages. But CRAO is an unusual presentation. CASE PRESENTATION A 27-year-old healthy female nurse of Indian descent presented with sudden vision loss in her right eye upon awakening. Central retinal artery occlusion (CRAO), combined with mild central retinal vein occlusion (CRVO), was diagnosed. During the second of three consecutive sessions of hyperbaric oxygen treatments, her vision rapidly improved. One week later, she developed peripheral phlebitis in the same eye. Infectious, inflammatory, and hematologic etiologies were excluded. The systemic evaluation was normal except for a positive Mantoux tuberculin skin test. Following systemic steroidal treatment, she experienced gradual improvement of her vasculitis. Two weeks later, mild retinal phlebitis appeared in her left eye. Eales' disease was diagnosed after the exclusion of other diseases. CONCLUSION This is an unusual Eales' disease case, which presented as combined CRAO with mild CRVO. The association of CRAO and Eales' disease is reported here for the first time, to our best knowledge.
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Affiliation(s)
- Dua Masarwa
- Department of Ophthalmology, Barzilai University Medical Center, Ashkelon, Israel.
| | - Eyal Raskin
- Goldschleger Eye Institute, Sheba Medical Center, Ramat Gan, Israel
| | - Keren Haas
- Department of Ophthalmology, Barzilai University Medical Center, Ashkelon, Israel
| | - Reut Singer
- Goldschleger Eye Institute, Sheba Medical Center, Ramat Gan, Israel
| | - David Hauser
- Department of Ophthalmology, Barzilai University Medical Center, Ashkelon, Israel
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17
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Okonkwo ON, Agweye CT, Akanbi T. Neuroprotection for Nonarteritic Central Retinal Artery Occlusion: Lessons from Acute Ischemic Stroke. Clin Ophthalmol 2023; 17:1531-1543. [PMID: 37284058 PMCID: PMC10239763 DOI: 10.2147/opth.s403433] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 05/19/2023] [Indexed: 06/08/2023] Open
Abstract
Nonarteritic central retinal artery occlusion (NA-CRAO) is a variant of acute ischemic stroke (AIS) and is a cause of sudden severe loss of vision. There are guidelines by the American Heart Association and the American Stroke Association for the care of CRAO patients. This review explores the basis of retinal neuroprotection for CRAO and its potential for improving the outcome of NA-CRAO. Recently, there have been significant advances in research into the use of neuroprotection to treat retinal diseases, including retinal detachment, age-related macular degeneration, and inherited retinal diseases. Also, neuroprotective research in AIS has been extensive, and newer drugs tested, including Uric acid, Nerinetide, and Otaplimastat, with promising results. Progress in cerebral neuroprotection after AIS offers hope for retinal neuroprotection after CRAO; and a possibility of extrapolating research findings from AIS into CRAO. Combining neuroprotection and thrombolysis can extend the therapeutic window for NA-CRAO treatment and potentially improve outcomes. Experimented neuroprotection for CRAO includes Angiopoietin (Comp Ang1), KUS 121, Gene therapy (XIAP), and hypothermia. Efforts in the field of neuroprotection for NA-CRAO should focus on better imaging to delineate the penumbra after an acute episode of NA-CRAO (using a combination of high-definition optical coherence angiography and electrophysiology). Also, research should explore details of pathophysiologic mechanisms involved in NA-CRAO, allowing for further neuroprotective intervention, and closing the gap between preclinical and clinical neuroprotection.
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Affiliation(s)
- Ogugua Ndubuisi Okonkwo
- Department of Ophthalmology, Eye Foundation Hospital and Eye Foundation Retina Institute, Ikeja, Lagos, Nigeria
| | - Chineze Thelma Agweye
- Department of Ophthalmology, University of Calabar and University of Calabar Teaching Hospital, Cross River, Nigeria
| | - Toyin Akanbi
- Department of Ophthalmology, Eye Foundation Hospital and Eye Foundation Retina Institute, Ikeja, Lagos, Nigeria
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Tayyab H, Aamir FB, Kirmani S. Central retinal artery occlusion as a result of symptomatic patent foramen ovale. Rom J Ophthalmol 2023; 67:69-72. [PMID: 37089812 PMCID: PMC10117189 DOI: 10.22336/rjo.2023.12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/12/2023] [Indexed: 04/25/2023] Open
Abstract
Objective: The objective of this case report is to highlight the importance of patent foramen ovale (PFO) as a potential cause of central retinal artery occlusion (CRAO). Methods: A teenage girl presented with a sudden painless onset of vision loss in the right eye, which was accompanied by frontal headaches and vertigo. The patient was referred to the Ophthalmology Department, where subsequent examination revealed a best corrected visual acuity of 20/ 400 and a positive relative afferent pupillary defect (RAPD) in the right eye. Fundoscopy and optical coherence tomography confirmed the diagnosis of central retinal artery occlusion following which investigations to rule out hematologic, vascular, and cardiac causes were performed. Results: Transoesophageal echocardiography revealed PFO as the cause of this cryptogenic stroke. All the necessary blood testing work was performed (complete blood counts, erythrocyte sedimentation rate, C-reactive protein, lipid profile, homocysteine levels, prothrombin time, activated partial thromboplastin time, international normalized ratio, liver, renal and thyroid function tests, antinuclear antibodies, anti-smooth muscle antibodies, anti-mitochondrial antibodies, p-ANCA, c-ANCA, anti-cardiolipin antibodies, protein C, Protein S, activated protein C resistance, anti-thrombin III, VDRL, antibodies for viral retinitis, angiotensin converting enzyme, Mantoux test, detailed urine and electrolyte reports). Transoesophageal echocardiography revealed right to left shunt. Conclusions: This case along with other reported evidence in literature support the strong connection between PFO and CRAO. Closure of symptomatic PFO may result in prevention of severe visual loss. Abbreviations: CRAO = central retinal artery occlusion, PFO = patent foramen ovale, RAPD = relative afferent pupillary defect, BCVA = best corrected visual acuity, OCT = Optical coherence tomography, IOP = Intraocular pressures, TTE = transthoracic echocardiography, HM = hand motion, TEE = transesophageal echocardiogram.
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Affiliation(s)
- Haroon Tayyab
- Department of Ophthalmology and Visual Sciences, The Aga Khan University Hospital, Karachi, Pakistan
| | - Faiqa Binte Aamir
- Department of Ophthalmology and Visual Sciences, The Aga Khan University Hospital, Karachi, Pakistan
| | - Salman Kirmani
- Division of Women and Child Health, The Aga Khan University Hospital, Karachi, Pakistan
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19
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Lee CT, Hsieh TH, Chu CC, Hsu YR, Wang JH, Wang JK, Zhao Z, Chang HT. Hyperbaric oxygen therapy as rescue therapy for pediatric frosted branch angiitis with Purtscher-like retinopathy: A case report. Front Med (Lausanne) 2023; 10:1119623. [PMID: 37138735 PMCID: PMC10149671 DOI: 10.3389/fmed.2023.1119623] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 03/29/2023] [Indexed: 05/05/2023] Open
Abstract
Introduction Frosted branch angiitis (FBA) is an uncommon uveitis characterized by fulminant retinal vasculitis. Purtscher-like retinopathy (PuR) is a rare retinal angiopathy associated with a non-traumatic etiology. Both FBA and PuR can cause profound visual impairments. Case report We describe the case of a 10-year-old male who presented with sudden bilateral painless visual loss due to FBA with concurrent PuR, with notable viral prodrome 1 month prior to presentation. Systemic investigations revealed a recent herpes simplex virus 2 infection with a high titer of IgM, positive antinuclear antibody (ANA) (1:640), and abnormal liver function tests. After administration of systemic corticosteroids, anti-viral agents, and subsequent immunosuppressive medications, the FBA was gradually alleviated. However, fundoscopy and optical coherence tomography (OCT) revealed persistent PuR and macular ischemia. Hence, hyperbaric oxygen therapy was administered as a rescue strategy, which resulted in gradual bilateral visual acuity improvement. Conclusion Hyperbaric oxygen therapy may be a beneficial rescue treatment for retinal ischemia secondary to FBA with PuR.
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Affiliation(s)
- Chi-Tai Lee
- Center of Hyperbaric Oxygen, Far Eastern Memorial Hospital, New Taipei City, Taiwan
- Department of Chest Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Tzu-Han Hsieh
- Department of Ophthalmology, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Chan-Ching Chu
- Center of Hyperbaric Oxygen, Far Eastern Memorial Hospital, New Taipei City, Taiwan
- Department of Chest Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Yung-Ray Hsu
- Department of Ophthalmology, Far Eastern Memorial Hospital, New Taipei City, Taiwan
- Department of Electrical Engineering, Yuan Ze University, Taoyuan, Taiwan
| | - Jia-Horng Wang
- Department of Critical Care Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Jia-Kang Wang
- Department of Ophthalmology, Far Eastern Memorial Hospital, New Taipei City, Taiwan
- Department of Electrical Engineering, Yuan Ze University, Taoyuan, Taiwan
| | - Zhanqi Zhao
- Department of Biomedical Engineering, Fourth Military Medical University, Xi’an, China
- Institute of Technical Medicine, Furtwangen University, Villingen-Schwenningen, Germany
| | - Hou-Tai Chang
- Center of Hyperbaric Oxygen, Far Eastern Memorial Hospital, New Taipei City, Taiwan
- Department of Critical Care Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan
- Department of Industrial Engineering and Management, Yuan Ze University, Taoyuan, Taiwan
- *Correspondence: Hou-Tai Chang,
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20
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[Retinal arterial occlusions (RAV) : S2e guidelines of the German Society of Ophthalmology (DOG), the German Retina Society (RG) and the German Professional Association of Ophthalmologists (BVA). Version: 7 October 2022]. DIE OPHTHALMOLOGIE 2023; 120:15-29. [PMID: 36525048 DOI: 10.1007/s00347-022-01780-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/14/2022] [Indexed: 12/23/2022]
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21
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Management of ocular arterial ischemic diseases: a review. Graefes Arch Clin Exp Ophthalmol 2023; 261:1-22. [PMID: 35838806 DOI: 10.1007/s00417-022-05747-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 06/19/2022] [Accepted: 06/28/2022] [Indexed: 01/05/2023] Open
Abstract
PURPOSE To summarize the existing treatment options regarding central retinal artery occlusion (CRAO), branch retinal artery occlusion (BRAO), arteritic anterior ischemic optic neuropathy (AAION), non-arteritic anterior ischemic optic neuropathy (NAION), and ocular ischemic syndrome (OIS), proposing an approach to manage and treat these patients. METHODS A systematic literature search of articles published since 1st January 2010 until 31st December 2020 was conducted using MEDLINE (PubMed), Scopus, and Web of Science. Exclusion criteria included case reports, non-English references, articles not conducted in humans, and articles not including diagnostic or therapeutic options. Further references were gathered through citation tracking, by hand search of the reference lists of included studies, as well as topic-related European society guidelines. RESULTS Acute ocular ischemia, with consequent visual loss, has a variety of causes and clinical presentations, with prognosis depending on an accurate diagnosis and timely therapeutic implementation. Unfortunately, most of the addressed entities do not have a standardized management, especially regarding their treatment, which often lacks good quality evidence on whether it should or not be used to treat patients. CONCLUSION Ophthalmologic signs and symptoms may be a warning sign of cardiovascular or cerebrovascular events, namely stroke. Most causes of acute ocular ischemia do not have a standardized management, especially regarding their treatment. Timely intervention is essential to improve the visual, and possibly vital, prognosis. Awareness must be raised among non-ophthalmologist clinicians that might encounter these patients. Further research should focus on assessing the benefit of the management strategies already being employed .
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22
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Indications for Emergent Hyperbaric Oxygen Therapy. CURRENT EMERGENCY AND HOSPITAL MEDICINE REPORTS 2022. [DOI: 10.1007/s40138-022-00251-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
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Rozenberg A, Hadad A, Peled A, Dubinsky-Pertzov B, Or L, Eting E, Efrati S, Pras E, Einan-Lifshitz A. Hyperbaric oxygen treatment for non-arteritic central retinal artery occlusion retrospective comparative analysis from two tertiary medical centres. Eye (Lond) 2022; 36:1261-1265. [PMID: 34140653 PMCID: PMC9151674 DOI: 10.1038/s41433-021-01617-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Revised: 05/07/2021] [Accepted: 05/25/2021] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVES To compare the visual outcome of patients treated for non-arthritic central retinal artery occlusion (CRAO) in a medical centre that uses hyperbaric oxygen therapy (HBOT) as part of the standard of care (SOC) to medical centres that does not. METHODS The study included data from two tertiary medical centres. The medical records of all patients diagnosed with non-arthritic CRAO without a patent cilioretinal artery between January 2010 and December 2018 in two tertiary medical centres were reviewed. RESULTS One hundred and twenty-one patients were treated by HBOT and 23 patients received only SOC. In the HBOT group, best-corrected visual acuity (BCVA) improved from 2.89 ± 0.98 logMAR at presentation to 2.15 ± 1.07 logMAR upon the end of HBOT (P < 0.001), while the SOC group had no significant improvement, from 3.04 ± 0.82 logMAR at presentation to 2.80 ± 1.50 logMAR (P = 0.24). With adjustment for age, gender, and the duration of symptoms, final BCVA in the HBOT group was significantly better compared to the control group (P = 0.023). Rates of patients achieving vision of 20/200 or better were similar between groups (17.4% vs. 19.8%, P = 0.523). CONCLUSION Utilizing HBOT as part of the SOC for CRAO improves the final visual outcome. HBOT is safe and can be implemented, if available, as part of SOC in all tertiary medical centres.
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Affiliation(s)
- Assaf Rozenberg
- Department of Ophthalmology, Shamir Medical Center, Zerifin, Israel.
| | - Aviel Hadad
- grid.412686.f0000 0004 0470 8989Department of Ophthalmology, Soroka Medical Center, Be’ersheba, Israel
| | - Alon Peled
- Department of Ophthalmology, Shamir Medical Center, Zerifin, Israel
| | | | - Lior Or
- Department of Ophthalmology, Shamir Medical Center, Zerifin, Israel
| | - Eva Eting
- Department of Ophthalmology, Shamir Medical Center, Zerifin, Israel
| | - Shai Efrati
- Sagol Center for Hyperbaric Medicine and Research, Shamir Medical Center, Zerifin, Israel
| | - Eran Pras
- Department of Ophthalmology, Shamir Medical Center, Zerifin, Israel
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Mortada H, Seraj H, Barasain O, Bamakhrama B, Alhindi NI, Arab K. Ocular Complications Post-Cosmetic Periocular Hyaluronic Acid Injections: A Systematic Review. Aesthetic Plast Surg 2022; 46:760-773. [PMID: 35091771 DOI: 10.1007/s00266-021-02730-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 12/12/2021] [Indexed: 12/29/2022]
Abstract
BACKGROUND With the global rise in the use of hyaluronic acid (HA) fillers as a minimally invasive cosmetic procedure, significant adverse effects such as vascular compromise and blindness have become common. Hence, we present the first systematic review aimed to investigate ocular complications secondary to a facial HA injection and to understand the presentation, cause, management, and outcome of these complications. METHODS The preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines were used to report this review. A systematic search was performed in July 2021 for published literature using the PubMed, MEDLINE, and Cochrane databases. The following terms were used: facial fillers, facial injections, hyaluronic acid, blindness, ophthalmoplegia, diplopia, ptosis, ophthalmic artery occlusion, posterior ciliary artery occlusion, and ocular ischemic syndrome. RESULTS A total of 2496 publications were searched, and 34 articles published between January 2000 and July 2021 were included. Twenty-seven case reports and seven case series were evaluated. The nose was the most common site of injection (n = 25; 40.67%). Ocular pain was the most common initial symptom of ocular complications (n = 13, 22.41 %). The most common complication was vision loss (n = 17, 50%). The majority of patients received hyaluronidase, aspirin, and steroids. Regarding the outcome, 15 (45.45%) of the published studies showed no improvement in complications even after management. CONCLUSION HA is gaining popularity in cosmetic applications. Post-HA ocular complications nearly always have an immediate onset. Proper knowledge of potential adverse events is crucial for clinicians to attempt to decrease complications and improve outcomes. LEVEL OF EVIDENCE III This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
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Affiliation(s)
- Hatan Mortada
- Division of Plastic Surgery, Department of Surgery, King Saud University Medical City, King Saud University and Department of Plastic Surgery & Burn Unit, King Saud Medical City, Riyadh, Saudi Arabia.
| | - Hadeel Seraj
- Department of Ophthalmology, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Omar Barasain
- College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Basma Bamakhrama
- Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | | | - Khalid Arab
- Division of Plastic Surgery, Department of Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
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25
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Rosignoli L, Chu ER, Carter JE, Johnson DA, Sohn JH, Bahadorani S. The Effects of Hyperbaric Oxygen Therapy in Patients with Central Retinal Artery Occlusion - A Retrospective Study, Systematic Review and Meta-analysis. KOREAN JOURNAL OF OPHTHALMOLOGY 2021; 36:108-113. [PMID: 34743490 PMCID: PMC9013555 DOI: 10.3341/kjo.2021.0130] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 11/05/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose Central retinal artery occlusion (CRAO) is a vision-threatening condition with a potentially poor visual prognosis. Many different treatment modalities are suggested but controversy remains regarding effectiveness of these treatments. The purpose of this study is to perform a systematic review and meta-analysis in addition to analyzing retrospective data at our own tertiary care center regarding effectiveness of hyperbaric oxygen therapy (HBOT) in treatment of CRAO. Methods The PubMed, Scopus, and the Cochrane Library are searched from the date of database inception to September 2021 to conduct a review based on the PRISMA (preferred reporting items for systematic review and meta-analysis), evaluating the role of HBOT in visual recovery of CRAO patients. In addition, a retrospective chart review of patients clinically diagnosed with CRAO at our university-based hospital (University of Texas Health, San Antonio, TX, USA) from year 2011 to 2021 was conducted. Results After a review of 376 articles, three articles met the inclusion criteria for meta-analysis, where a total of 207 patients received HBOT versus 89 patients that did not receive any form of oxygen therapy. Analysis of these results demonstrate that HBOT in CRAO patients does not enhance the final visual outcome (p = 0.83). Similar conclusion was also drawn from retrospective analysis of 48 patients (15 HBOT versus 33 controls) at our tertiary care center, where no visual benefit was observed in the HBOT group. Conclusions HBOT does not appear to improve final visual outcome and concerns remain regarding adverse reactions such as barotrauma and generalized seizures. Large, randomized studies are required for further understanding of the role of HBOT in treatment of CRAO.
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Affiliation(s)
- Luca Rosignoli
- Department of Ophthalmology University of Texas Health at San Antonio San Antonio, TX, United States
| | - Edward R Chu
- Department of Ophthalmology University of Texas Health at San Antonio San Antonio, TX, United States
| | - John E Carter
- Department of Ophthalmology University of Texas Health at San Antonio San Antonio, TX, United States
| | - Daniel A Johnson
- Department of Ophthalmology University of Texas Health at San Antonio San Antonio, TX, United States
| | - Jeong-Hyeon Sohn
- Department of Ophthalmology University of Texas Health at San Antonio San Antonio, TX, United States
| | - Sepehr Bahadorani
- Department of Ophthalmology University of Texas Health at San Antonio San Antonio, TX, United States
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26
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Masters TC, Westgard BC, Hendriksen SM, Decanini A, Abel AS, Logue CJ, Walter JW, Linduska J, Engel KC. CASE SERIES OF HYPERBARIC OXYGEN THERAPY FOR CENTRAL RETINAL ARTERY OCCLUSION. Retin Cases Brief Rep 2021; 15:783-788. [PMID: 31306292 DOI: 10.1097/icb.0000000000000895] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
PURPOSE To retrospectively report the outcomes of patients presenting to our facility with central retinal artery occlusion and receiving therapy with hyperbaric oxygen (HBO). METHODS This was a retrospective, chart review at a single hospital center. Patients with diagnosed central retinal artery occlusion were treated with HBO twice daily for 5 days during their inpatient stay for a total of 10 HBO treatments. Main outcome was change from the documented presenting best-corrected visual acuity to discharge best-corrected visual acuity. Thirty-nine patients with central retinal artery occlusion were included in the analysis during a 30-month period. RESULTS Twenty-eight of 39 patients (72%) had some improvement in acuity. There was a mean of 5.05 lines of improvement using a modified Snellen chart after completing their HBO treatment course. Patients treated within 12 hours of symptom onset showed the greatest improvement in their visual acuity (6.11 mean lines of improvement). Complications of therapy included middle ear barotrauma (10/39) and confinement anxiety (1/39) and did not interfere with the therapy regimen or hospital course. CONCLUSION This retrospective case series supports the use of emergent HBO therapy as a viable treatment option for patients with central retinal artery occlusion. Hyperbaric oxygen therapy was safely administered and well tolerated.
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Affiliation(s)
- Thomas C Masters
- Department of Emergency Medicine, Division of Hyperbaric Medicine
| | - Bjorn C Westgard
- Department of Emergency Medicine, Division of Hyperbaric Medicine
| | | | - Alejandra Decanini
- Department of Ophthalmology, Hennepin County Medical Center, Minneapolis, Minnesota
| | - Anne S Abel
- Department of Ophthalmology, Hennepin County Medical Center, Minneapolis, Minnesota
| | | | - Joseph W Walter
- Department of Emergency Medicine, Division of Hyperbaric Medicine
| | - Joseph Linduska
- Department of Ophthalmology, Hennepin County Medical Center, Minneapolis, Minnesota
| | - Kevin C Engel
- Department of Ophthalmology, Hennepin County Medical Center, Minneapolis, Minnesota
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27
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Celebi ARC. Hyperbaric Oxygen Therapy for Central Retinal Artery Occlusion: Patient Selection and Perspectives. Clin Ophthalmol 2021; 15:3443-3457. [PMID: 34413628 PMCID: PMC8370578 DOI: 10.2147/opth.s224192] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Accepted: 08/04/2021] [Indexed: 12/22/2022] Open
Abstract
The central retinal artery occlusion (CRAO) is a rare ophthalmological emergency that can occur in the eye. CRAO can affect persons of any age, however it is most common in people over the age of 60. CRAO is associated with a number of risk factors, including giant cell arteritis, carotid artery atherosclerosis, cardiogenic emboli, hypertension, smoking, diabetes, and thromboembolic disease. The chance of each of these etiologies being present is assessed during the course of the investigation. Hyperbaric oxygen treatment (HBOT) is classified by the American Heart Association for CRAO at level IIb. In accordance with that, HBOT might be considered for the treatment of such a severe condition. HBOT can maintain retinal oxygenation during ischemic events by allowing oxygen to diffuse through choroidal capillaries that have been exposed to elevated partial pressures of oxygen. As a result, ischemia-related damage is reversed if applied within proper time frame. The amount of time that has passed prior to initiation of HBOT is considered to be the most critical factor in determining the best visual prognosis. According to the Undersea and Hyperbaric Medical Society, patients who are identified with CRAO after the onset of symptoms should be evaluated for HBOT within 24 hours. HBOT has the advantage of having a low risk profile, and it can be utilized to improve visual outcomes in proper patients.
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Affiliation(s)
- Ali Riza Cenk Celebi
- Atakent Education and Research Hospital, Department of Ophthalmology, Acibadem University School of Medicine, Istanbul, Turkey
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28
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Balal S, J'Bari AS, Hassan A, Sharma A, Wagner SK, Pasu S. Capturing the Occult Central Retinal Artery Occlusion Using Optical Coherence Tomography. Curr Eye Res 2021; 46:1762-1767. [PMID: 33882770 DOI: 10.1080/02713683.2021.1921219] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Aims: To report spectral-domain optical coherence tomography (OCT) findings in cases of impending or occult central retinal artery occlusion (CRAO) in which a diagnosis other than CRAO was made on initial presentation.Methods: Retrospective, observational case series of patients diagnosed with CRAO for whom on initial presentation fundal examination and OCT findings were deemed unremarkable and/or a diagnosis other than CRAO was made. OCT images from the initial presentation were then reviewed for evidence of inner retinal ischaemia.Results: In total, 214 cases of CRAO were identified. Eleven patients (5.14%) had been given an alternative initial diagnosis at their first presentation in casualty and were included. The age range was 20-84 years and 81% (9/11) were male. On review of initial OCT imaging performed in casualty, all cases had evidence of inner retinal ischaemia.Conclusions: CRAO is an ophthalmic emergency which leads to vision loss which is often irreversible. Examination of the fundus may be normal early in the course of the disease and therefore a timely diagnosis may be missed. This case series reports the OCT findings of inner retinal ischaemia in patients with occult or impending CRAO which may aid in the early diagnosis and referral to stroke services.
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Affiliation(s)
- Shafi Balal
- Ophthalmology Department, Moorfields Eye Hospital NHS Trust, London, UK.,Institute of Ophthalmology, University College London, London, UK
| | - Ahmed Said J'Bari
- Ophthalmology Department, The Royal Free London NHS Foundation Trust, London, UK
| | - Ali Hassan
- Ophthalmology Department, Moorfields Eye Hospital NHS Trust, London, UK.,Institute of Ophthalmology, University College London, London, UK
| | - Anant Sharma
- Ophthalmology Department, Moorfields Eye Hospital NHS Trust, London, UK
| | - Siegfried Karl Wagner
- Ophthalmology Department, Moorfields Eye Hospital NHS Trust, London, UK.,Institute of Ophthalmology, University College London, London, UK
| | - Saruban Pasu
- Ophthalmology Department, East Sussex Healthcare NHS Trust, East Sussex, UK
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29
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Mac Grory B, Schrag M, Biousse V, Furie KL, Gerhard-Herman M, Lavin PJ, Sobrin L, Tjoumakaris SI, Weyand CM, Yaghi S. Management of Central Retinal Artery Occlusion: A Scientific Statement From the American Heart Association. Stroke 2021; 52:e282-e294. [PMID: 33677974 DOI: 10.1161/str.0000000000000366] [Citation(s) in RCA: 119] [Impact Index Per Article: 29.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
PURPOSE Central retinal artery occlusion (CRAO) is a form of acute ischemic stroke that causes severe visual loss and is a harbinger of further cerebrovascular and cardiovascular events. There is a paucity of scientific information on the appropriate management of CRAO, with most strategies based on observational literature and expert opinion. In this scientific statement, we critically appraise the literature on CRAO and provide a framework within which to consider acute treatment and secondary prevention. METHODS We performed a literature review of randomized controlled clinical trials, prospective and retrospective cohort studies, case-control studies, case reports, clinical guidelines, review articles, basic science articles, and editorials concerning the management of CRAO. We assembled a panel comprising experts in the fields of vascular neurology, neuro-ophthalmology, vitreo-retinal surgery, immunology, endovascular neurosurgery, and cardiology, and document sections were divided among the writing group members. Each member received an assignment to perform a literature review, synthesize the data, and offer considerations for practice. Multiple drafts were circulated among the group until consensus was achieved. RESULTS Acute CRAO is a medical emergency. Systems of care should evolve to prioritize early recognition and triage of CRAO to emergency medical attention. There is considerable variability in management patterns among practitioners, institutions, and subspecialty groups. The current literature suggests that treatment with intravenous tissue plasminogen activator may be effective. Patients should undergo urgent screening and treatment of vascular risk factors. There is a need for high-quality, randomized clinical trials in this field.
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30
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John Blegen HM, Reed DS, Giles GB, Wedel ML, Hobbs SD. Long-Term Outcomes After Central Retinal Artery Occlusion Treated Acutely With Hyperbaric Oxygen Therapy: A Case Series. JOURNAL OF VITREORETINAL DISEASES 2021; 5:142-146. [PMID: 37009086 PMCID: PMC9979062 DOI: 10.1177/2474126420951989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose: This study assesses the long-term outcomes, including neovascular complications, of central retinal artery occlusion (CRAO) treated acutely with hyperbaric oxygen therapy (HBOT). Methods: Four cases of CRAO treated acutely with HBOT were reviewed. Visual and structural outcomes were reviewed. Ocular complications including neovascularization were assessed and risk factors determined. Results: Two patients with a history of non-insulin dependent diabetes mellitus (NIDDM) developed early-onset ocular neovascularization within 1 month following treatment, with final vision of light perception over 1 year after injury. One patient with NIDDM and 1 patient without NIDDM did not develop ocular neovascularization; both had improvement in final visual acuity to 20/400 and 20/250, respectively. Conclusions: Patients treated acutely with HBOT for CRAO may require more frequent and earlier monitoring for complications, especially in patients with diabetes. Further research is needed to determine the long-term safety and efficacy of HBOT for CRAO, especially in the setting of systemic disease such as diabetes.
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Affiliation(s)
- Halward Martin John Blegen
- Department of Ophthalmology, Brooke Army Medical Center, Fort Sam Houston, San Antonio, TX, USA
- Wilford Hall Eye Center, Lackland Air Force Base, San Antonio, TX, USA
| | - Donovan Stephen Reed
- Department of Ophthalmology, Brooke Army Medical Center, Fort Sam Houston, San Antonio, TX, USA
- Wilford Hall Eye Center, Lackland Air Force Base, San Antonio, TX, USA
| | - Gregory Bryant Giles
- Department of Ophthalmology, Brooke Army Medical Center, Fort Sam Houston, San Antonio, TX, USA
- Wilford Hall Eye Center, Lackland Air Force Base, San Antonio, TX, USA
| | - Marissa L. Wedel
- Department of Ophthalmology, Brooke Army Medical Center, Fort Sam Houston, San Antonio, TX, USA
| | - Samuel David Hobbs
- Department of Ophthalmology, Brooke Army Medical Center, Fort Sam Houston, San Antonio, TX, USA
- Wilford Hall Eye Center, Lackland Air Force Base, San Antonio, TX, USA
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31
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Du HY, Wang R, Li JL, Luo H, Xie XY, Yan R, Jian YL, Cai JY. Ligustrazine induces viability, suppresses apoptosis and autophagy of retinal ganglion cells with ischemia/reperfusion injury through the PI3K/Akt/mTOR signaling pathway. Bioengineered 2021; 12:507-515. [PMID: 33522374 PMCID: PMC8806313 DOI: 10.1080/21655979.2021.1880060] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Ligustrazine, an alkaloid monomer extracted from Chuanxiong Rhizoma, has the function of protecting nerve cells. However, the effect and mechanism of ligustrazine on retinal ischemia/reperfusion (I/R) injury still need to be clarified. In our study, retinal ganglion cells (RGC-5) were used to establish a retinal I/R injury model by anaerobic cultivation. Cell viability, autophagy, and apoptosis were evaluated by cell counting kit 8 assay, transmission electron microscopy, and TUNEL staining after treatment with ligustrazine, PI3K inhibitor Ly294002, and/or mTOR inhibitor rapamycin, respectively. Besides, the levels of PI3K/Akt/mTOR pathway and autophagy-related proteins were determined by western blot. Moreover, one-way ANOVA was adopted for inter-group comparisons of measurement data. Our results demonstrated that low-concentration ligustrazine significantly enhanced cell viability and suppressed cell autophagy and apoptosis of RGC-5 cells after I/R injury, suggesting the protective effect of low-concentration ligustrazine on retinal I/R injury. Moreover, the alleviating effect of ligustrazine on RGC-5 with retinal I/R injury was mechanistically associated with the activation of the PI3K/Akt/mTOR pathway. In conclusion, low-concentration ligustrazine has a significant protective effect on RGC-5 cells with retinal I/R injury by activating the PI3K/Akt/mTOR pathway.
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Affiliation(s)
- Hong-Yan Du
- Department of Ophthalmology, The Affiliated Traditional Chinese Medicine Hospital of Guangzhou Medical University , Guangzhou, China
| | - Rong Wang
- Department of Ophthalmology, The Affiliated Traditional Chinese Medicine Hospital of Guangzhou Medical University , Guangzhou, China
| | - Jian-Liang Li
- Department of Ophthalmology, The Affiliated Traditional Chinese Medicine Hospital of Guangzhou Medical University , Guangzhou, China
| | - Huang Luo
- Department of Ophthalmology, The Affiliated Traditional Chinese Medicine Hospital of Guangzhou Medical University , Guangzhou, China
| | - Xiao-Yan Xie
- Department of Ophthalmology, The Affiliated Traditional Chinese Medicine Hospital of Guangzhou Medical University , Guangzhou, China
| | - Ran Yan
- Department of Ophthalmology, The Affiliated Traditional Chinese Medicine Hospital of Guangzhou Medical University , Guangzhou, China
| | - Yue-Ling Jian
- Department of Ophthalmology, The Affiliated Traditional Chinese Medicine Hospital of Guangzhou Medical University , Guangzhou, China
| | - Jin-Ying Cai
- Department of Ophthalmology, The Affiliated Traditional Chinese Medicine Hospital of Guangzhou Medical University , Guangzhou, China
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32
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Sharma RA, Newman NJ, Biousse V. Conservative treatments for acute nonarteritic central retinal artery occlusion: Do they work? Taiwan J Ophthalmol 2021; 11:16-24. [PMID: 33767952 PMCID: PMC7971444 DOI: 10.4103/tjo.tjo_61_20] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 09/10/2020] [Indexed: 11/13/2022] Open
Abstract
Acute central retinal arterial occlusion has a very poor visual prognosis. Unfortunately, there is a dearth of evidence to support the use of any of the so-called "conservative" treatment options for CRAO, and the use of thrombolytics remains controversial. In this review, we address a variety of these "conservative" pharmacologic treatments (pentoxifylline, isosorbide dinitrate, and acetazolamide) and nonpharmacologic approaches (carbogen, hyperbaric oxygen, ocular massage, anterior chamber paracentesis, laser embolectomy, and hemodilution) that have been proposed as potential treatments of this condition. We conclude that the available evidence for all treatments is insufficient to conclude that any treatment will influence the natural history of this disorder. Management of CRAO patients should instead focus on reducing the risk of subsequent ischemic events, including cerebral stroke. Certain patients may be considered for acute treatment with thrombolytics, although further research must clarify the efficacy, safety, and optimal use of these therapies.
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Affiliation(s)
- Rahul A. Sharma
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Nancy J. Newman
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia, USA
- Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, USA
- Department of Neurological Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Valérie Biousse
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia, USA
- Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, USA
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33
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Cho SI, Kim JH, Cho NC. The Effect of Intra-arterial Thrombolysis in Retinal Artery Occlusion: Case Series and Literature Review. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2020. [DOI: 10.3341/jkos.2020.61.12.1442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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34
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Murchison AP, Sweid A, Dharia R, Theofanis TN, Tjoumakaris SI, Jabbour PM, Bilyk JR. Monocular visual loss as the presenting symptom of COVID-19 infection. Clin Neurol Neurosurg 2020; 201:106440. [PMID: 33383464 PMCID: PMC7831816 DOI: 10.1016/j.clineuro.2020.106440] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 12/06/2020] [Accepted: 12/10/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND AND IMPORTANCE Additional time is needed to determine the exact impact of COVID-19 on acute cerebrovascular disease incidence, but recently published data has correlated COVID-19 to large vessel occlusion strokes. CLINICAL PRESENTATION We report the first case of central retinal artery occlusion (CRAO) as the initial manifestation of COVID-19 infection. Subsequent neuroimaging revealed a large thrombus extending into the internal carotid artery. CONCLUSION This case illustrates the need to suspect COVID-19 infection in patients presenting with retinal arterial occlusion, including individuals who are asymptomatic or minimally symptomatic for COVID-19 infection.
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Affiliation(s)
- Ann P Murchison
- Eye Emergency Room, Wills Eye Hospital & Associate Professor, Department of Emergency Medicine, Thomas Jefferson University Hospital, Philadelphia, PA, United States; Oculoplastic and Orbital Surgery Service, Wills Eye Hospital, Philadelphia, PA, United States.
| | - Ahmad Sweid
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, United States.
| | - Robin Dharia
- Department of Neurology, Thomas Jefferson University Hospital, Philadelphia, PA, United States.
| | - Thana N Theofanis
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, United States.
| | - Stavropoula I Tjoumakaris
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, United States.
| | - Pascal M Jabbour
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, United States.
| | - Jurij R Bilyk
- Oculoplastic and Orbital Surgery Service, Wills Eye Hospital, Philadelphia, PA, United States.
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35
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Performing hyperbaric oxygen therapy for central retinal artery occlusion under COVID-19: From myringotomy to rapid viral test. HEALTH POLICY AND TECHNOLOGY 2020; 10:29-30. [PMID: 33194540 PMCID: PMC7647891 DOI: 10.1016/j.hlpt.2020.10.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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36
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Polak N, Fishelev G, Lang E, Wang Z, Neheman A, Ben Haim Y, Hadanny A, Efrati S. Hyperbaric Oxygen as Salvage Therapy for Neonates Suffering From Critical Ischemia of the Glans Penis After Circumcision. Urology 2020; 149:e48-e51. [PMID: 32956687 DOI: 10.1016/j.urology.2020.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 08/28/2020] [Accepted: 09/07/2020] [Indexed: 10/23/2022]
Abstract
Ischemic complications of glans penis following circumcision are rare, and if occurs can culminate in irreversible necrosis with severe long-term consequences. Here we present 2 challenging cases of neonates suffering from acute severe glans penis ischemia after circumcision that were treated by hyperbaric oxygen treatment (HBOT). In addition to case presentations, the literature related to complications of circumcision and the physiological effects of HBOT are being reviewed. Based on the review and the case presented, we conclude that HBOT can be used as salvage treatment for circumcision induced glans ischemia as early as possible before full necrosis develops.
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Affiliation(s)
- Nir Polak
- Sagol Center for Hyperbaric Medicine & Research, Shamir (Assaf-Harofeh) Medical Center, Israel, affiliated to Sackler School of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel.
| | - Gregory Fishelev
- Sagol Center for Hyperbaric Medicine & Research, Shamir (Assaf-Harofeh) Medical Center, Israel, affiliated to Sackler School of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel
| | - Erez Lang
- Sagol Center for Hyperbaric Medicine & Research, Shamir (Assaf-Harofeh) Medical Center, Israel, affiliated to Sackler School of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel
| | - Zemer Wang
- Sagol Center for Hyperbaric Medicine & Research, Shamir (Assaf-Harofeh) Medical Center, Israel, affiliated to Sackler School of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel
| | - Amos Neheman
- Sagol Center for Hyperbaric Medicine & Research, Shamir (Assaf-Harofeh) Medical Center, Israel, affiliated to Sackler School of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel
| | - Yacov Ben Haim
- Sagol Center for Hyperbaric Medicine & Research, Shamir (Assaf-Harofeh) Medical Center, Israel, affiliated to Sackler School of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel
| | - Amir Hadanny
- Sagol Center for Hyperbaric Medicine & Research, Shamir (Assaf-Harofeh) Medical Center, Israel, affiliated to Sackler School of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel
| | - Shai Efrati
- Sagol Center for Hyperbaric Medicine & Research, Shamir (Assaf-Harofeh) Medical Center, Israel, affiliated to Sackler School of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel; Sackler School of Medicine and Sagol School of Neuroscience, Tel-Aviv University, Tel Aviv-Yafo, Israel
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Chowdhary S, Sawhney V, Pandya A, Sambhav K, Gupta SK. Central Retinal Artery Occlusion After Nasosinal Surgery - an Insight. Int Med Case Rep J 2020; 13:211-215. [PMID: 32547258 PMCID: PMC7247723 DOI: 10.2147/imcrj.s247275] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Accepted: 04/07/2020] [Indexed: 11/23/2022] Open
Abstract
Objective To describe a case of central retinal artery occlusion (CRAO) after nasosinal surgery and subject's subsequent response to hyperbaric oxygen therapy (HBOT). Design Observational case report. Results We describe a subject with diagnosed CRAO after septoplasty, bilateral inferior turbinate reduction and balloon sinuplasty, who was given hyperbaric oxygen treatment after four days of onset of CRAO with an improvement in visual acuity and visual field. Conclusion Even though CRAO has been rarely reported after ENT procedures and HBOT has been previously described for the treatment, this is the case report where hyperbaric oxygen was given after four days of onset, with a possible improvement.
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Affiliation(s)
- Somya Chowdhary
- Bascom Palmer Eye Institute, University of Miami, Miami, FL, USA
| | | | | | - Kumar Sambhav
- Department of Ophthalmology, University of Florida, Jacksonville, FL, USA
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Lin LJ, Chen TX, Wald KJ, Tooley AA, Lisman RD, Chiu ES. Hyperbaric oxygen therapy in ophthalmic practice: an expert opinion. EXPERT REVIEW OF OPHTHALMOLOGY 2020. [DOI: 10.1080/17469899.2020.1739523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Lawrence J. Lin
- Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health, New York, NY, USA
| | - Tiffany X. Chen
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, USA
- Department of Neurology, NYU Langone Health, New York, NY, USA
| | - Kenneth J. Wald
- Department of Ophthalmology, NYU Langone Health, New York, NY, USA
| | - Andrea A. Tooley
- Department of Ophthalmology, NYU Langone Health, New York, NY, USA
| | | | - Ernest S. Chiu
- Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health, New York, NY, USA
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Abstract
A 60-year-old hypertensive lady experienced painless sudden visual loss in the right eye when resting at home. There was no traumatic injury, no eye pain, or flashes or floaters, or nausea, but mild right-sided headache for few days. She was not lifting heavy objects, nor straining. She managed to attend the emergency department within 1 h of onset of symptoms by herself walking into the consultation room unaided. Examination showed visual acuity with pinhole of hand movement over the right eye, right relative afferent pupillary defect and normal intraocular pressure of 15 mmHg. Extraocular movement was full without diplopia or pain. Eyes were not injected, and slit lamp examination was normal with clear cornea. Acute management of vascular causes of acute blindness and the role of hyperbaric oxygen therapy in ophthalmological disease in Hong Kong will be discussed.
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Affiliation(s)
- Sunny Chi Lik Au
- Department of Ophthalmology, Tung Wah Eastern Hospital, Causeway Bay, Hong Kong
| | - Simon Tak Chuen Ko
- Department of Ophthalmology, Tung Wah Eastern Hospital, Causeway Bay, Hong Kong
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Lee JS, Kim JY, Jung C, Woo SJ. Iatrogenic ophthalmic artery occlusion and retinal artery occlusion. Prog Retin Eye Res 2020; 78:100848. [PMID: 32165219 DOI: 10.1016/j.preteyeres.2020.100848] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 03/03/2020] [Accepted: 03/04/2020] [Indexed: 01/19/2023]
Abstract
Iatrogenic ophthalmic artery occlusion (IOAO) is a rare but devastating ophthalmic disease that may cause sudden and permanent visual loss. Understanding the possible etiologic modalities and pathogenic mechanisms of IOAO may prevent its occurrence. There are numerous medical etiologies of IOAO, including cosmetic facial filler injection, intravascular procedures, intravitreal gas or drug injection, retrobulbar anesthesia, intraarterial chemotherapy in retinoblastoma. Non-ocular surgeries and vascular events in arteries that are not directly associated with the ophthalmic artery, can also cause IOAO. Since IOAO has a limited number of treatment modalities, which lead to poor final visual prognosis, it is imperative to acknowledge the information regarding medical procedures that are etiologically associated with IOAO. We accumulated all searchable and available IOAO case reports (our cases and previous reported cases from the literature), classified them according to their mechanisms of pathogenesis, and summarized treatment options and responses of each of the causes. Various sporadic cases of IOAO can be categorized into three mechanisms as follows: intravascular event, orbital compartment syndrome, and increased intraocular pressure. Embolic IOAO, which is considered the primary cause of the condition, was classified into three subgroups according to the pathway of embolic movement (retrograde pathway, anterograde pathway, pathway through collateral channels). Despite the practical limitations of treating spontaneous (non-iatrogenic) retinal artery occlusion, this article will contribute in predicting and improving the prognosis of IOAO by recognizing the treatable factors. Furthermore, it is expected to provide clues to future research associated with the treatment of retinal artery occlusion.
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Affiliation(s)
- Jong Suk Lee
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Jun Yup Kim
- Department of Neurology, Seoul National University College of Medicine, Cerebrovascular Center, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Cheolkyu Jung
- Department of Radiology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Se Joon Woo
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.
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41
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Hyperbaric Oxygen Therapy in Retinal Arterial Occlusion: Epidemiology, Clinical Approach, and Visual Outcomes. Case Rep Ophthalmol Med 2019; 2019:9765938. [PMID: 32089924 PMCID: PMC7012270 DOI: 10.1155/2019/9765938] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 11/23/2019] [Accepted: 11/28/2019] [Indexed: 11/18/2022] Open
Abstract
Purpose To evaluate the efficacy and safety of hyperbaric oxygen therapy (HBOT) in patients with acute retinal artery occlusion (RAO). Secondarily, to analyse the epidemiology and the clinical approach. Methods Retrospective study of 13 patients submitted to HBOT between 2013 and 2018. The analysed parameters consisted of: systemic history, time between symptoms onset and treatment, initial approach, number of HBOT sessions, complications of HBOT and best corrected visual acuity—BCVA (of the total sample, central RAO—CRAO—group, and branch RAO—BRAO group). Results Arterial hypertension was the most prevalent systemic risk factor (53.8%). Initial therapies were 100% normobaric oxygen administration, topical and oral hypotensive medication, eye massage and aspirin. CRAO was observed in 69.2% and BRAO in 30.8% of the cases, with clinically significant visual improvement (a decrease in logMAR of 0.3) in 55.5% and 75%, respectively. Time between symptoms onset and treatment had a median of 9 hours. The median number of HBOT sessions was 7, without complications. Conclusions HBOT provide BCVA improvement in patients with RAO, when it is performed in an early time after the symptom onset. It seems to be an effective and safe therapeutic option for a pathology that still remains without approved treatment.
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42
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Weymouth W, Pedersen C. Central Retinal Artery Occlusion Associated with Carotid Artery Occlusion. Clin Pract Cases Emerg Med 2019; 3:233-236. [PMID: 31403098 PMCID: PMC6682253 DOI: 10.5811/cpcem.2019.4.40847] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Revised: 03/26/2019] [Accepted: 04/01/2019] [Indexed: 01/22/2023] Open
Abstract
Sudden, painless vision loss in patients with stroke risk factors is suspect for central retinal artery occlusion (CRAO), an ophthalmic emergency that in addition to ocular treatment warrants a thorough neurologic and vascular evaluation. In addition to the high risk of concurrent stroke, carotid artery stenosis and occlusion is often overlooked during the initial evaluation. Here we report a case of CRAO with concurrent ipsilateral complete left internal carotid artery (ICA) occlusion and right ICA critical narrowing, dissection and pseudoaneurysm, which subsequently improved with prompt hyperbaric oxygen therapy.
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Affiliation(s)
- Wells Weymouth
- San Antonio Military Medical Center, Department of Emergency Medicine, Fort Sam Houston, Texas
| | - Craig Pedersen
- San Antonio Military Medical Center, Department of Emergency Medicine, Fort Sam Houston, Texas
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The Effects of Hyperbaric Oxygen at Different Pressures on Oxidative Stress and Antioxidant Status in Rats. ACTA ACUST UNITED AC 2019; 55:medicina55050205. [PMID: 31137620 PMCID: PMC6572368 DOI: 10.3390/medicina55050205] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 02/24/2019] [Accepted: 05/21/2019] [Indexed: 02/07/2023]
Abstract
Background: The optimal use of oxygen at greater than atmospheric pressures in any operational or therapeutic application (hyperbaric oxygen, HBO2) requires awareness of the fact that the beneficial effects of oxygen coexist with toxic effects depending on the pressure and duration of exposure. In this study, we aimed to investigate the effect of HBO2 therapy on oxidative stress and antioxidant status in commonly used protocol for acute HBO2 indications, such as carbon monoxide intoxication, central retinal artery occlusion, crush injury, gas gangrene, and to compare it with normobaric oxygen (NBO2) in healthy rats. Materials and Methods: Fifty-six male, young adult Wistar albino rats were randomly divided into seven groups and named as Group I through Group VII. Plasma malondialdehyde (MDA), superoxide dismutase (SOD), and erythrocyte glutathione (GSH) levels in control group were compared to the levels in other groups. Results: The increases in MDA levels and the decrease in SOD activities were statistically significant in HBO2 groups at the end of the first 24 h when compared to the control group, and the significant decrease in erythrocyte GSH level was only at 2.4 atmospheres absolute. Conclusions: The present study showed that pressure and frequency of exposure are important factors to consider when investigating HBO2-induced oxidative stress and antioxidant response.
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44
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Chronopoulos A, Schutz JS. Central retinal artery occlusion-A new, provisional treatment approach. Surv Ophthalmol 2019; 64:443-451. [PMID: 30707925 DOI: 10.1016/j.survophthal.2019.01.011] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 01/13/2019] [Accepted: 01/17/2019] [Indexed: 10/27/2022]
Abstract
The retinal ganglion cells infarcted in central retinal artery occlusion (CRAO) are the somata of the optic nerve axons, part of the central nervous system. Consequently, CRAO with inner retinal infarction is a small vessel stroke, usually with the devastating consequence of severe visual loss in the affected eye. At present, there is no generally accepted, evidence-based therapy of nonarteritic CRAO in contrast to ischemic cerebral stroke that has well-accepted treatment protocols. Widely divergent and controversial therapeutic options for CRAO reflect the desperation of treating physicians and disparate conflicting studies. We examine reasons why treatment of nonarteritic CRAO remains problematic and then suggest a provisional new approach to treatment based on updated understanding of CRAO pathophysiology and analysis of current therapeutic options and their rationales.
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Affiliation(s)
- Argyrios Chronopoulos
- Department of Ophthalmology, Hospital of Ludwigshafen, Teaching Hospital of the University of Johannes Gutenberg-University Mainz, Mainz, Germany; Department of Ophthalmology, University Hospitals and School of Medicine, Geneva, Switzerland.
| | - James S Schutz
- Department of Ophthalmology, University Hospitals and School of Medicine, Geneva, Switzerland
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45
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Sharma RA, Dattilo M, Newman NJ, Biousse V. Treatment of Nonarteritic Acute Central Retinal Artery Occlusion. Asia Pac J Ophthalmol (Phila) 2018; 7:235-241. [PMID: 29717825 DOI: 10.22608/apo.201871] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Central retinal artery occlusion (CRAO) is an event most often caused by an embolus originating in the ipsilateral carotid artery, aortic arch, or heart. CRAO may result from partial or complete occlusion of the central retinal artery (CRA), which acts as the primary blood supply to the inner neurosensory retina, and typically results in profound vision loss and permanent visual disability. No consensus has emerged regarding the optimal treatment of CRAO. All proposed treatments are of questionable efficacy and many have uncertain risk profiles. In certain circumstances, thrombolysis may be attempted as a treatment option; however, the evidence to support broad use of thrombolytics in the treatment of acute CRAO remains elusive. It is known that the risk factors that predispose to other cardiovascular and cerebrovascular events are often present in CRAO. Accordingly, identification of patients at highest risk of stroke and secondary prevention of ischemic events remains the primary focus of management. This review offers a summary of the clinical presentation, diagnosis, and prognosis of CRAO, with an emphasis on treatment options.
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Affiliation(s)
- Rahul A Sharma
- Department of Ophthalmology, The University of Ottawa, Ottawa, ON, Canada
| | - Michael Dattilo
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, GA
| | - Nancy J Newman
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, GA
- Department of Neurology, Emory University School of Medicine, Atlanta, GA
- Department of Neurological Surgery, Emory University School of Medicine, Atlanta, GA
| | - Valerie Biousse
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, GA
- Department of Neurology, Emory University School of Medicine, Atlanta, GA
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Tobalem S, Schutz JS, Chronopoulos A. Central retinal artery occlusion - rethinking retinal survival time. BMC Ophthalmol 2018; 18:101. [PMID: 29669523 PMCID: PMC5907384 DOI: 10.1186/s12886-018-0768-4] [Citation(s) in RCA: 106] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Accepted: 04/03/2018] [Indexed: 01/05/2023] Open
Abstract
Background The critical time from onset of complete occlusion of the central retinal artery (CRA) to functionally significant inner retinal infarction represents a window of opportunity for treatment and also has medical-legal implications, particularly when central retinal artery occlusion (CRAO) complicates therapeutic interventions. Here, we review the evidence for time to infarction from complete CRAO and discuss the implications of our findings. Methods A Medline search was performed using each of the terms “central retinal artery occlusion”, “retinal infarction”, “retinal ischemia”, and “cherry red spot” from 1970 to the present including articles in French and German. All retrieved references as well as their reference lists were screened for relevance. An Internet search using these terms was also performed to look for additional references. Results We find that the experimental evidence showing that inner retinal infarction occurs after 90–240 min of total CRAO, which is the interval generally accepted in the medical literature and practice guidelines, is flawed in important ways. Moreover, the retinal ganglion cells, supplied by the CRA, are part of the central nervous system which undergoes infarction after non-perfusion of 12–15 min or less. Conclusions Retinal infarction is most likely to occur after only 12–15 min of complete CRAO. This helps to explain why therapeutic maneuvers for CRAO are often ineffective. Nevertheless, many CRAOs are incomplete and may benefit from therapy after longer intervals. To try to avoid retinal infarcton from inadvertent ocular compression by a headrest during prone anesthesia, the eyes should be checked at intervals of less than 15′.
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Affiliation(s)
- Stephan Tobalem
- Department of Ophthalmology, University Hospitals and School of Medicine, Geneva, Switzerland
| | - James S Schutz
- Department of Ophthalmology, University Hospitals and School of Medicine, Geneva, Switzerland
| | - Argyrios Chronopoulos
- Department of Ophthalmology, University Hospitals and School of Medicine, Geneva, Switzerland. .,Department of Ophthalmology, Addenbrooke's Hospital, Cambridge University Hospital NHS Foundation Trust, Box 41, Hills Road, Cambridge, CB2 0QQ, UK.
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47
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Youn TS, Lavin P, Patrylo M, Schindler J, Kirshner H, Greer DM, Schrag M. Current treatment of central retinal artery occlusion: a national survey. J Neurol 2017; 265:330-335. [PMID: 29236169 DOI: 10.1007/s00415-017-8702-x] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Revised: 12/05/2017] [Accepted: 12/06/2017] [Indexed: 01/15/2023]
Abstract
BACKGROUND Central retinal artery occlusion (CRAO) is an ophthalmological emergency, the retinal analog of a stroke. To date there is no consensus or national guidelines on how this disorder should be managed. As academic neurologists and ophthalmologists treat CRAO frequently, we set out to understand how these clinicians approach patients with CRAO with a national survey. METHODS We identified university-associated teaching hospitals offering vascular neurology, neuro-ophthalmology and/or retina fellowships in the US and asked the directors of the programs to respond to questions in an open response format to profile the acute management of CRAO at their institution. RESULTS We found remarkable heterogeneity in the approach to acute treatment of patients with CRAO among the 45 institutions that responded to the survey. Only 20% had a formal policy, guideline or white paper to standardize the approach to treatment. The primary treating physician was an ophthalmologist, neurologist, or neuro-ophthalmologist 44, 27, and 4% of the time, respectively; 24% were co-managed acutely by neurology and ophthalmology. Intravenous fibrinolysis was offered to selected patients in 53% of institutions, and was the preferred initial treatment in 36%. When the acute treatment team involved a vascular neurologist, fibrinolysis was more likely to be considered a first-line treatment (p < 0.05). Anterior chamber paracentesis, ocular massage and hyperbaric oxygen therapy were offered 42, 66 and 7% of the time, respectively, while 9% of institutions offered no treatment. Anterior chamber paracentesis was more likely to be offered at programs where neurologists were not involved in treating CRAOs (p < 0.001). At 35% of institutions, patients with acute CRAO were not routinely referred to a general emergency room for initial evaluation and treatment. Carotid imaging was routinely obtained by 89% of programs, magnetic resonance imaging of the brain by 69%, echocardiogram by 62%, laboratory screening for an inflammatory state by 27% and retinal angiography by 30%. The thoroughness of vascular risk factors' screening was greater in programs that routinely referred acute CRAO cases to the emergency department. CONCLUSIONS This survey shows that there is significant variability in treatment practices for acute CRAO in the US. Because of the high cerebrovascular and cardiovascular risk reported in this population of patients, it is notable that the approach to risk factor screening is also highly variable and many programs do not routinely refer patients to an emergency department for urgent evaluation. Finally, there appears to be equipoise among treatment teams regarding the efficacy of systemic fibrinolysis, as 53% of programs report a willingness to treat at least some patients with this modality.
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Affiliation(s)
- Teddy S Youn
- Department of Neurology, University of Florida College of Medicine, Gainesville, FL, USA
| | - Patrick Lavin
- Department of Ophthalmology, Vanderbilt University School of Medicine, Nashville, TN, USA.,Department of Neurology, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Morgan Patrylo
- Department of Neurology, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Joseph Schindler
- Department of Neurology, Yale University School of Medicine, New Haven, CT, USA
| | - Howard Kirshner
- Department of Neurology, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - David M Greer
- Department of Neurology, Boston University School of Medicine, Boston, MA, USA
| | - Matthew Schrag
- Department of Neurology, Vanderbilt University School of Medicine, Nashville, TN, USA.
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