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Published on: January 18, 2018
Comparative efficacy of conservative, hyperbaric oxygen, and endovascular retinal surgery approaches in central
Ryota Akai1,2, Masaaki Ishida1, Tomoko Ueda-Consolvo1
1Department of Ophthalmology, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, 2630 Sugitani, Toyama, 930-0194, Japan.
Insights
Endovascular retinal surgery (ERS) significantly improved vision in central retinal artery occlusion (CRAO) patients more than hyperbaric oxygen therapy (HBOT) or conservative treatments. ERS offers the most substantial visual acuity gains for CRAO.
Area of Science:
- Ophthalmology
- Vascular Medicine
- Surgical Innovation
Background:
- Central retinal artery occlusion (CRAO) is a critical condition leading to vision loss.
- Effective treatment strategies for CRAO are continuously being investigated to improve patient outcomes.
Purpose of the Study:
- To compare the efficacy of three distinct treatment modalities for CRAO: conservative therapy, hyperbaric oxygen therapy (HBOT), and endovascular retinal surgery (ERS).
Main Methods:
- Retrospective analysis of CRAO patients treated at Toyama University Hospital.
- Treatments included conservative measures (ocular massage, sublingual nitroglycerin), HBOT (2 atmospheres for 60 minutes), and ERS (vitrectomy with tPA injection).
- Visual acuity was measured using logMAR units, with statistical analysis employing paired t-test, Kruskal-Wallis, and Mann-Whitney U-tests.
Main Results:
- Conservative therapy showed minimal change in visual acuity (1.96 to 1.88, p=0.56).
- Hyperbaric oxygen therapy (HBOT) resulted in significant visual improvement (1.79 to 1.28, p=0.007).
- Endovascular retinal surgery (ERS) demonstrated the most substantial visual acuity improvement (1.98 to 0.68, p=0.0000413), significantly outperforming other methods.
Conclusions:
- Conservative treatment alone appears insufficient for significant visual recovery in CRAO.
- Both HBOT and ERS show promise for treating CRAO, with ERS yielding superior visual outcomes.
- ERS represents a highly effective intervention for improving visual acuity in patients with central retinal artery occlusion.
Purpose:
To assess and compare the efficacy of three treatment modalities for central retinal artery occlusion (CRAO): conservative therapy, hyperbaric oxygen therapy (HBOT), and endovascular retinal surgery (ERS).
Patients And Methods:
We retrospectively analyzed the cases of CRAO patients treated at the Toyama University Hospital. Their age range was 44-87 years; a balanced gender distribution was observed. The conservative therapy group included 13 eyes (6 males, 7 females, average age 74 years). HBOT group: 11 eyes from 10 patients (5 males, 5 females, average age 70 years). ERS group: 10 eyes (7 males, 3 females, average age 74 years). The treatments were as follows. Conservative group: ocular massage and sublingual nitroglycerin. HBOT: 60-min sessions at 2 atmospheres. ERS: vitrectomy followed by tissue plasminogen activator injection using a 47-ga. microneedle. Visual acuity was assessed using logMAR units, with statistical analyses by paired t-test, Kruskal-Wallis test, and Mann-Whitney U-test with Bonferroni correction.
Results:
The conservative group showed a slight visual acuity change from 1.96 ± 0.53 to 1.88 ± 0.56 (p = 0.56). The HBOT group exhibited a significant improvement from 1.79 ± 0.80 to 1.28 ± 0.81 (p = 0.007). The ERS group displayed the most substantial improvement, with scores moving from 1.98 ± 0.36 to 0.68 ± 0.49 (p = 0.0000413). The ERS group's outcomes were significantly superior to those of the other groups.
Conclusion:
These results suggest that while conservative treatment may not be sufficient, both HBOT and endovascular retinal surgery show promise, with the latter demonstrating the most significant improvement.
