The effects of hyperbaric oxygen treatment for non-arteritic central retinal artery occlusion (HBOT-CRAO)

Central retinal artery occlusion (CRAO) is a rare form of acute ischemic stroke that causes severe visual loss, which is a relatively rare emergency but devastating eye condition. There is currently no guideline-endorsed treatment for CRAO. Data on hyperbaric oxygen therapy (HBOT) for CRAO is minimal. We aimed to investigate the benefit of HBOT in patients with non-arteritic CRAO.

We conducted a retrospective study from two medical centers that recruited patients with diagnosed non-arteritic CRAO from January 2019 to December 2024. HBOT was offered to CRAO patients who presented to the emergency room within 24 h from symptom onset. Seventeen patients underwent a full course of HBOT (twice a day for five days with a total of 10 HBO treatments). Sixteen CRAO patients received partial HBOT (from 1 to 7 treatments); HBOT was discontinued per patients' request, either due to varied reasons or no noted visual improvement. Thirty-two CRAO patients did not undergo HBOT due to being outside of the treatment window. The primary outcome was visual improvement at the time of discharge. Student's t-test, Mann-Whitney U (Wilcoxon rank sum) test, and Chi-square test were used to compare the change in LogMAR best-corrected visual acuity (BCVA) in patients before and after HBOT.

There was no statistical difference among the three groups in patient demographic and clinical characteristics (vascular risk factors). In the HBOT group, patients who received a full course of HBOT (twice a day for five days) revealed significant visual improvement at discharge evaluation with LogMAR BCVA (p = 0.01). The benefit was not found in patients with partial or no HBOT. Only one patient developed an episode of seizure while receiving HBOT; no complications occurred in the rest of the patients.

HBOT improves visual outcomes in CRAO patients who received an entire course of therapy. The benefit from HBOT does not improve the visual outcome in patients who receive partial or no treatment HBOT. Our results suggest that HBOT is safe and may be considered as a treatment option for patients with CRAO who present to the hospital within 24 h of symptom onset.