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Efficacy and Safety of Hyperbaric Oxygen Therapy for Retinal Artery Occlusion: A Systematic Review and Meta-Analysis

Published online by Cambridge University Press:  31 July 2025

Mohamed Elfil Open the ORCID record for Mohamed Elfil [Opens in a new window] ,
Hanin Sabet ,
Abdallah Abbas Open the ORCID record for Abdallah Abbas [Opens in a new window] ,
Ahmed Bayoumi Open the ORCID record for Ahmed Bayoumi [Opens in a new window] ,
Hazem S. Ghaith ,
Mohamed Hesham Ghoneem ,
Amr Shaarawy ,
Monsef Ibrahim Kharboush ,
Mohammad Aladawi Open the ORCID record for Mohammad Aladawi [Opens in a new window]  and
Zaid Najdawi
...Show all authors
Mohamed Elfil
Affiliation:
Department of Neurology, University of Miami/Jackson Health System, Miami, FL, USA
Hanin Sabet
Affiliation:
Faculty of Medicine, South Valley University, Qena, Egypt
Abdallah Abbas
Affiliation:
Faculty of Medicine, Al-Azhar University, Damietta, Egypt
Ahmed Bayoumi
Affiliation:
Department of Neurology, McGovern Medical School at UTHealth Houston, Houston, TX, USA
Hazem S. Ghaith
Affiliation:
Faculty of Medicine, Al-Azhar University, Cairo, Egypt
Mohamed Hesham Ghoneem
Affiliation:
Department of Ophthalmology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
Amr Shaarawy
Affiliation:
Alexandria Ophthalmology Hospital, Alexandria, Egypt
Monsef Ibrahim Kharboush
Affiliation:
Department of Ophthalmology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
Mohammad Aladawi
Affiliation:
Department of Neurology, University of Alabama, Birmingham, AL, USA
Zaid Najdawi
Affiliation:
Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, NE, USA
Chaitanya Medicherla
Affiliation:
Department of Neurology, Westchester Medical Center, Valhalla, NY, USA
Daniel A. Schwartz
Affiliation:
Department of Neurology, Westchester Medical Center, Valhalla, NY, USA
Kelly A. Hutcheson
Affiliation:
Department of Ophthalmology, Westchester Medical Center, Valhalla, NY, USA
Daniel Elefant
Affiliation:
Department of Ophthalmology, Westchester Medical Center, Valhalla, NY, USA
Gurmeen Kaur
Affiliation:
Department of Neurosurgery, Westchester Medical Center, Valhalla, NY, USA
Chirag D. Gandhi
Affiliation:
Department of Neurosurgery, Westchester Medical Center, Valhalla, NY, USA
Fawaz Al-Mufti*
Affiliation:
Department of Neurosurgery, Westchester Medical Center, Valhalla, NY, USA
*
Corresponding author: Fawaz Al-Mufti; Email: Fawaz.al-mufti@wmchealth.org.
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Abstract

Background:

Retinal artery occlusion (RAO) is a vision-threatening condition with limited therapeutic options. Hyperbaric oxygen therapy (HBOT) has emerged as a potential treatment to enhance retinal oxygenation and salvage ischemic tissue, though its efficacy and safety remain debated.

Methods:

We followed the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines and the Cochrane Handbook for Systematic Reviews of Interventions. Databases were searched through November 2024 for studies comparing HBOT with control in RAO patients. Risk of bias was assessed using the Newcastle-Ottawa Scale. Meta-analyses evaluated visual acuity (VA), best-corrected visual acuity (BCVA) and adverse events (AEs).

Results:

Nine studies with 499 patients (286 HBOT, 213 non-HBOT) met the inclusion criteria. HBOT was associated with improved BCVA (MD: –0.63, 95% CI: [–1.14, –0.12], p = 0.01) after sensitivity analysis. No significant differences were observed in uncorrected VA or lines of improvement. AEs included seizures (1.47%), ear barotrauma (1.65%) and epistaxis (0.83%) in the HBOT group. Notably, HBOT was associated with lower rates of neovascular glaucoma (7.89% vs. 15.79%) and stroke (4.3% vs. 16.6%) compared to controls.

Conclusions:

HBOT demonstrates potential for improved visual outcomes in RAO patients, particularly BCVA, with a generally favorable safety profile. However, heterogeneity among studies and limited sample sizes highlight the need for robust prospective trials to clarify its role in RAO management.

Résumé

RÉSUMÉL’efficacité et l’innocuité de l’oxygénothérapie hyperbare dans l’occlusion de l’artère rétinienne : résultats d’une revue systématique et d’une méta-analyse.Contexte :

L’occlusion de l’artère rétinienne (OAR) est une affection qui met la vision en danger, et dans laquelle les moyens thérapeutiques sont difficiles à cerner. L’oxygénothérapie hyperbare (OHB) est perçue comme une nouvelle forme de traitement susceptible d’améliorer l’oxygénation de la rétine et, par le fait même, de sauver le tissu en état d’ischémie, bien que l’efficacité et l’innocuité du traitement fassent débat.

Méthode :

L’équipe de recherche a suivi les lignes directrices décrites dans les Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) et les Cochrane Handbook for Systematic Reviews of Interventions. Les membres du groupe ont entrepris des recherches dans des bases de données jusqu’en novembre 2024 inclusivement afin de trouver des études portant sur la comparaison de l’OHB avec des traitements témoins chez des patients ayant subi une OAR. Le risque de biais a été évalué à l’aide de l’échelle de Newcastle-Ottawa. La méta-analyse avait pour objet l’évaluation de l’acuité visuelle (AV), de la meilleure acuité visuelle corrigée (MAVC) et des événements indésirables (EI).

Résultats :

Au total, 9 études groupant 499 patients (286 OHB; 213 non-OHB) respectaient les critères d’inclusion. D’après une analyse de la sensibilité, l’OHB a été associée à une amélioration de la MAVC (différence moyenne : −0,63; IC à 95 % : [−1,14 à −0,12]; p = 0,01). Aucune différence importante n’a été relevée en ce qui concerne l’AV non corrigée et le nombre de lignes d’amélioration. Les EI comprenaient les crises d’épilepsie (1,47 %), les barotraumatismes de l’oreille (1,65 %) et les épistaxis (0,83 %) dans le groupe de l’OHB. Point intéressant à souligner, l’OHB a été associée à une diminution du taux de glaucome néovasculaire (7,89 % contre [c.] 15,79 %) et d’accident vasculaire cérébral (4,3 % c. 16,6 %) comparativement aux témoins.

Conclusion :

L’oxygénothérapie hyperbare a démontré, dans l’étude, son potentiel d’amélioration des résultats cliniques visuels, notamment la MAVC, chez les patients ayant subi une OAR, ce à quoi s’ajoute une marge d’innocuité généralement favorable. Toutefois, l’hétérogénéité des études et la petite taille des échantillons font ressortir la nécessité de réaliser des essais prospectifs robustes afin que soit clarifié le rôle de l’OHB dans la prise en charge de l’OAR.

Keywords

Central retinal artery occlusionhyperbaric oxygenmeta-analysisretinal ischemiaretinal artery occlusion

Information

Type
Original Article
Information
Canadian Journal of Neurological Sciences , First View , pp. 1 - 10
Copyright
© The Author(s), 2025. Published by Cambridge University Press on behalf of Canadian Neurological Sciences Federation

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