Introduction:

Central retinal artery occlusion (CRAO) is a severe ocular emergency that can lead to sudden and profound vision loss. Hyperbaric oxygen therapy (HBOT) has emerged as a potential treatment option for CRAO, offering the potential to restore retinal perfusion and improve visual outcomes. This article provides a comprehensive exploration of the use of HBOT in the treatment of CRAO, including its mechanism of action, clinical benefits, treatment protocol, and considerations.

Mechanism of Action:

HBOT for CRAO works through several mechanisms:

• Oxygenation of Ischemic Retina: By delivering 100% oxygen at increased atmospheric pressure, HBOT enhances oxygen delivery to the ischemic retina, promoting the survival of retinal cells and preserving visual function.
• Neovascularization Promotion: HBOT stimulates the release of growth factors and promotes neovascularization, which can help establish collateral circulation and improve retinal perfusion.
• Reduction of Retinal Edema: HBOT helps reduce retinal edema, potentially improving retinal oxygenation and restoring visual function.

Clinical Benefits of Hyperbaric Treatment for CRAO:

• Vision Improvement: HBOT has demonstrated the potential to improve or partially restore vision in some cases of CRAO, particularly when initiated early after the onset of symptoms.
• Preservation of Retinal Function: The enhanced oxygenation provided by HBOT may help preserve retinal function and reduce the risk of permanent visual impairment.
• Neovascularization Prevention: HBOT may prevent the development of neovascular complications associated with chronic retinal ischemia.

Hyperbaric Treatment Protocol for CRAO:

• Treatment Sessions: HBOT for CRAO typically involves a series of treatments delivered over consecutive days.
• Oxygen Delivery: Patients receive 100% oxygen inside a hyperbaric chamber at increased atmospheric pressure, typically ranging from 2 to 2.5 atmospheres absolute (ATA).
• Treatment Duration: The total duration of HBOT may vary but often consists of multiple daily sessions lasting for 90-120 minutes each.

Considerations in Hyperbaric Treatment for CRAO:

• Timely Initiation: Early initiation of HBOT is crucial to maximize the potential benefits in CRAO. Immediate ophthalmologic evaluation and prompt referral to a hyperbaric center are essential.
• Individualized Approach: The treatment protocol may be tailored based on the severity of CRAO, the duration of symptoms, and the patient's overall health status.
• Collaborative Care: Close collaboration between ophthalmologists and hyperbaric medicine specialists is necessary to ensure appropriate patient selection, treatment planning, and monitoring.

Conclusion:

Hyperbaric oxygen therapy holds promise as a potential treatment option for central retinal artery occlusion, offering the potential to improve visual outcomes and preserve retinal function. With early initiation and a collaborative approach, HBOT may play a valuable role in the comprehensive management of CRAO.

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