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Hyperbaric Oxygen Therapy For Retinal Artery Occlusion

Medical information reviewed by: IONUT CURELEA, Physical therapist

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Discover the hyperbaric medicine center opened in our clinic. Centrokinetic has the top-performing hyperbaric chamber in Bucharest, with multiple medical and anti-aging uses. The Baroks chamber has 5 seats, and operates at a constant pressure of 2.5 atmospheres, being fully automated and having protocols for each condition, and can be used individually for each patient. 

Hyperbaric oxygen therapy - benefits

Pacientii care apeleaza la serviciile de terapie hiperbara ale clinicii beneficiaza de:

  • The only medically accredited hyperbaric therapy chamber in Bucharest, which operates at 2.5 atmospheres (those for aesthetic use go to 1 atmosphere and have no medical benefits).
  • A safe medical procedure, without irradiation, without pain, without other side effects. 
  • The specialized medical team consists of recovery doctors, orthopedists, rheumatologists, neurologists, and neurosurgeons, meaning a multidisciplinary team specialized in all diseases that can be treated with hyperbaric therapy. 
  • Premium conditions at a fair price. Our clinic is recognized for the conditions offered and for the care of each patient. But we do not need to pay exorbitant prices to have access to quality medical services. At Centrokinetic you can find an affordable and fair price. But note that we do not have a contract with the National Health Insurance House (we do not offer state reimbursed services).

Centrokinetic is keeping contact with prestigious clinics and universities in Belgium, the Netherlands, France, and Greece to constantly update treatments to provide patients with the best medical solutions.

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What are the effects of oxygen therapy on the body?

  • Decreases inflammation
  • Increases the body's oxygen saturation by 20-30%
  • Increases the body's immunity
  • Increases blood circulation and stimulates the formation of new capillaries
  • Decreases toxins in the body
  • Stimulates the production of new blood cells
  • Increases healing rate

What is central retinal artery occlusion?

Central retinal artery occlusion (CRAO) is considered an ophthalmic emergency. The prognosis of this disease is very poor. Currently, there is no generally effective therapy to treat CRAO. Hyperbaric Oxygen Therapy (HBOT)may increase the volume of oxygen delivered to the ischemic retinal tissue to spontaneous or assisted reperfusion. We report the case of a patient who suffered a sudden visual loss due to CRAO and who received HBOT treatment. The patient was an 81-year-old woman who presented with CRAO in the right eye (OD). She showed poor visual acuity before treatment. She underwent three sessions of HBOT at a pressure of 2.8 absolute atmospheres, performed for 3 days. After 4 days in the hospital, her visual acuity improved to 0.4 (OD) for distant vision and 0.5 (OD) for near vision. Her vision was stable without oxygen; therefore, she was discharged.

Introduction

Central retinal artery occlusion (CRAO) is a devastating and common eye condition. CRAO presents a sudden, unilateral, and painless loss of vision. Even when treated promptly, an acute obstruction of the central retinal artery usually leads to severe and permanent loss of vision.

The specific cause of CRAO is unknown, occlusion can occur when the veins in the eyes are too narrow. Factors that can promote the occurrence of CRAO are atherosclerosis, diabetes, high blood pressure, high cholesterol, glaucoma, smoking.

Traditional CRAO treatments (eye massage, paracentesis of the anterior chamber, drugs to lower intraocular pressure, vasodilators, and oral diuretics) focus on moving the embolism downstream by lowering intraocular pressure and producing vasodilation. However, there are currently no effective therapies available for CRAO.

Another treatment for CRAO is hyperbaric oxygen therapy (HBOT). This involves inhaling pure oxygen at pressures exceeding 1 absolute atmosphere (ATA). During HBOT, the volume of dissolved oxygen in the plasma increases from 20 to 30 times. 

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Case study

An 81-year-old woman presented to the emergency department (ED) with a sudden and painless loss of vision in the right eye (OD). Her visual change had begun 10 hours before she was admitted to the study. The patient's medical history showed heart failure, atrial fibrillation, and a heart attack. She underwent cataract surgery on both eyes.

When the patient visited the ED, it was found that visual acuity was low only in the right eye and 0.4 on a decimal scale in the left eye (OS). Intraocular pressure was 14 mmHg in OD and 13 mmHg in the operating system. She had a grade 3 afferent pupillary defect in OD. The anterior segment of her eyes was evaluated using biomicroscopy, with no abnormal results found. 

An examination of the fundus revealed a slightly pale retina with a red spot on the macula. No definite evidence of plaque or embolism was noted. An optical coherence tomographic scan showed that there was a slight increase in the reflectivity of the inner retinal layer. The patient was instructed on how to perform a digital OD massage. Topical brimonidine and dorzolamide/timolol were also prescribed to maximize blood pressure.

Following the diagnosis of CRAO, we initiated oxygen therapy for 30 minutes through a facial mask with a reservoir bag (15 L / min), without a significant improvement in the patient's vision. Therefore, we decided to treat the patient with HBOT. Her vision failed to improve significantly at pressures of 2 and 2.4 ATA, and subsequently, the pressure was raised to 2.8 ATA. The patient indicated that the vision has a clarity similar to that before the CRAO diagnosis at 2.8 ATA, so we continued the treatment at a pressure of 2.8 ATA for 140 minutes in a multiplace chamber (IBEX Medical Systems, Seoul, Korea). 

After the first session, the patient's uncorrected visual acuity improved to 0.2 in OD and 0.5 in the operating system. After hospitalization, he received intermittent oxygen therapy for 15 minutes every hour, alternating with a 45-minute break in the hyperbaric chamber, followed by a treatment performed by an ophthalmologist who performed paracentesis of the anterior chamber. 

After the paracentesis of the anterior chamber, her visual acuity did not improve. The patient was also given 6 L / min of oxygen during sleep. If her visual acuity decreased, we planned to restart HBOT. The next day, the patient presented prompt light reflexes without relative afferent pupillary defects and an uncorrected view of 0.4 in OD and 0.6 in OS was recorded. When it was examined, it was noticed that the red dot was no longer visible on the retina. During the next day's HBOT session, the ophthalmologist was present to monitor visual improvement during HBOT.

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Her visual acuity for near vision in OD gradually increased during HBOT from 0.1 to 0.5. She received one HBOT treatment session (with the same treatment protocol for each session) per day for 3 days with intermittent oxygen therapy after HBOT. There were no complications during HBOT. On the fourth day, the patient's visual acuity remained 0.4 (OD) for distance vision and 0.5 (OD) for near vision, similar to that in the absence of oxygen. The patient was then discharged. She came back for a check up one month after her discharge from the ophthalmology clinic, and her visual acuity was maintained at 0.8 (OD) without complications such as neovascularization or changes in retinal pigment epithelium.

Discussion

The key reason for the poor prognosis following a CRAO diagnosis is that the retina is very sensitive to ischemia because retinal tissue demonstrates the highest rate of oxygen consumption per unit mass in the human body. The inner layers of the retina, which are normally oxygenated through the retinal circulation, usually lose viability following an occlusion, causing vision loss among patients with CRAO. However, if these layers can obtain enough oxygen by diffusion through the choroidal circulation, the inner layers of the retina will remain viable.

Oxygenation of the ischemic layers of the internal retina with HBOT depends on the choroidal perfusion that occurs under CRAO conditions. If the occlusion level is at the level of the ophthalmic artery, the supply of blood to the posterior ciliary vessels will also be blocked and there will be no collateral circulation to oxygenate the inner retina.
An adequate partial pressure of oxygen must be maintained to keep the retina viable until circulation is restored by natural recanalization, which usually occurs within 72 hours. Because there is not a single unique way to treat CRAO, in this case, several treatments were administered to maintain the patient's vision. In particular, there was a visual improvement immediately after the first HBOT session and an improvement in the patient's near vision after the second HBOT session, suggesting that the patient's visual improvement was probably due to HBOT. There are several limitations in this presentation of the case. First, fluorescein angiography was not performed. Therefore, the exact severity of the circulation defect could not be assessed. Secondly, Several treatment modalities have been applied to the patient because no single modality is sufficient to treat CRAO. Although there has been no visual improvement during other treatments, there is a possibility that vision may be helped in other ways.

Undersea & Hyperbaric Medical Society has recommended that patients presenting for treatment within 24 hours of the onset of symptoms be considered for HBOT. However, as health insurance does not currently cover the use of HBOT to treat CRAO in Korea, it is recommended that additional studies be conducted to evaluate the effects of HBOT among Korean patients with CRAO.

IN CASE YOU HAVEN'T ALREADY HEARD ABOUT US

Centrokinetic is the place where you will find clear answers and solutions for your motricity problems. The clinic is dedicated to osteoarticular diseases and is divided into the following specialized departments:

  • Orthopedics , a department composed of an extremely experienced team of orthopedic doctors, led by Dr. Andrei Ioan Bogdan, primary care physician in orthopedics-traumatology, with surgical activity at Medlife Orthopedic Hospital, specialized in sports traumatology and ankle and foot surgery. .
  • Pediatric orthopedics , where children's sports conditions are treated (ligament and meniscus injuries), spinal deformities (scoliosis, kyphosis, hyperlordosis) and those of the feet (hallux valgus, hallux rigidus, equine larynx, flat valgus, hollow foot).
  • Neurology , which has an ultra-performing department, where consultations, electroencephalograms (EEG) and electromyography (EMG) are performed. 
  • Medical recovery  for adults and  children , department specialized in the recovery of performance athletes, in spinal disorders, in the recovery of children with neurological and traumatic diseases. Our experience is extremely rich, treating over 5000 performance athletes.
  • Medical imaging , the clinic being equipped with ultrasound and MRI, high-performance devices dedicated to musculoskeletal disorders, and complemented by an experienced team of radiologists: Dr. Sorin Ghiea and Dr. Cosmin Pantu, specialized in musculoskeletal imaging.
Find the latest news by following the Facebook and YouTube accounts of the Centrokinetic clinic.  

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