Exploring hyperbaric oxygen therapy for central retinal artery occlusion beyond 24 h: case report

Central retinal artery occlusion (CRAO) is a rare emergency, often affecting individuals over 60, with risk factors such as hypertension, diabetes, and smoking. Hyperbaric oxygen therapy (HBOT), classified as level IIb by the American Heart Association for CRAO, helps maintain retinal oxygenation during ischemic events by diffusing oxygen through choroidal capillaries. While HBOT appears promising for addressing various vision-threatening conditions, including retinal occlusions and diabetic macular edema, it has not been officially approved for these indications. A 70-year-old male presented with painless vision loss in his right eye, noticed upon waking, accompanied by high blood pressure. On examination, light perception was detected in the right eye, and visual acuity in the left was 0.6. Biomicroscopy revealed CRAO in the right eye, with a cherry-red spot, retinal edema, and absent circulation. Optical coherence tomography (OCT) confirmed retinal edema and subretinal fluid. Given that the thrombolysis window had passed, HBOT was initiated within 48 h of presentation. Following the first treatment, the patient experienced improvement in vision, with light perception expanding beyond the peripheral area. CRAO is an ocular emergency, and early treatment is crucial for improving visual outcomes. HBOT, recommended within 6-12 h of diagnosis, has shown promise in restoring vision. In our case, HBOT administered within 48 h led to improved peripheral vision, with the presence of a cherry-red spot on the macula associated with better recovery. While HBOT can have side effects, none were observed here. Despite challenges in conducting large-scale trials, HBOT remains a potentially effective treatment for CRAO, especially if started early.