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Hyperbaric oxygen therapy (HBOT) is a primary or adjunctive therapy for a variety of medical disorders including some involving the eye. This paper is the first comprehensive review of HBOT for ocular indications. The authors recommend the following as ocular indications for HBOT: decompression sickness or arterial gas embolism with visual signs or...
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Context 1
... retinopathy was first reported in 1935 (300) and occurs months to years after retinal irradiation. This disorder clinically resembles diabetic retinopathy with retinal hemorrhages, cotton wool spots, lipid exudates, and capillary non-perfusion on IVFA (301) ( Figure 5). Although the threshold dose for radiation retinopathy is typically considered to be 2,500 to 3,000cGy, it has been reported after doses of 500 to 1,500 cGy (301). ...
Citations
... Few studies have explored the usefulness of HBOT in ophthalmic diseases. In 2008, Butler et al. [5] comprehensively reviewed the role of HBOT in ocular disorders by reviewing nine ocular disorders indicated to receive HBOT by the Undersea and Hyperbaric Medical Society, including decompression sickness or arterial gas embolism and carbon monoxide poisoning with visual symptoms. Other ocular indications for HBOT that are supported by considerable evidence include ischemic optic neuropathy, retinal artery/vein occlusion, and macular edema. ...
Hyperbaric oxygen therapy (HBOT) has been used for the past 50 years for conditions such as decompression disease and wound healing. It has promising effects in the treatment of vision-threatening diseases, such as retinal artery occlusion, retinal vein occlusion, diabetic macular edema, and acute optic neuropathy; however, HBOT has not been approved for use in these conditions by regulatory authorities. This paper provides an overview of the theoretical effectiveness and most recent indications for HBOT in ophthalmology. The fundamental aspects of the physiology of choroidal circulation and metabolism are provided together with the clinical aspects that should be accounted for when selecting patients for this therapy. The paper also presents case reports of when HBOT was successfully implemented. The goals of this review were to explore the indications and benefits of HBOT and to evaluate the effectiveness of HBOT as an intervention in treating ophthalmology disorders. Lastly, the paper details the side-effects and discusses the safety issues of HBOT.
... The exact pathogenesis is debated [41, 42, 43•, 44-46] and the efficacy is not proven. The protocol for hyperbaric oxygen varies in different studies, with an average of 2-2.5 atm for approximately 90 min within 8 h of onset of CRAO [47]. ...
Ab s t r ac t
Background: Presentation of seizures in patients with chronic obstructive pulmonary disease (COPD) is an infrequent finding. Posterior reversible
encephalopathy is a rare and potentially treatable entity in such scenarios.
Case description: We present a case of a 61-year-old female, with a diagnosed case of COPD for 5 years, on regular treatment. She was admitted
to the intensive care unit (ICU) with a history of fever, vomiting, and an increased level of drowsiness. She had shown good improvement with
the initial management of acute infective exacerbation of COPD. After 96 hours of admission, she had status epilepticus. Magnetic resonance
imaging (MRI) findings and clinical features solved the mystery of status epilepticus and altered sensorium. Presentation of posterior reversible
encephalopathy syndrome (PRES) in acute exacerbation of COPD is a rare condition but should be kept in mind as one of the important differential
diagnoses for those presenting with seizures with or without encephalopathy, even in the absence of accelerated hypertension. Neuroimaging
is essential for the exclusion of other possible conditions. PRES is treatable and reversible with or without full recovery.
Conclusion: Seizures in patients with COPD can be caused by PRES, which is a potentially reversible condition. A conclusive diagnosis can be
established by relevant neuroimaging.
Clinical significance: The PRES is a potential cause of seizures in patients with COPD.
Keywords: Case report, Chronic obstructive pulmonary disease, Posterior reversible encephalopathy syndrome, Seizure, Steroids.
Indian Journal of Critical Care Case Report (2023): 10.5005/jp-journals-11006-0074
... Hyperbaric oxygen therapy (HBOT) can be primary or adjunctive therapy for many disorders, including central retinal artery occlusion, periocular necrotizing fasciitis, ocular and periocular gas gangrene, and some eye diseases, such as periorbital reconstructive surgery [5]. HBOT can enhance wound healing by increasing tissue oxygenation, improving phagocytosis, and increasing leukocyte microbial killing ability [6]. ...
Purpose: This report presents the treatment of tissue necrosis after evisceration with hyperbaric oxygen therapy (HBOT) in a patient with pseudomonas endophthalmitis and orbital cellulitis. Methods: A 49-year-old woman was admitted to our clinic with severe pain and vision loss after cataract surgery 3 days before, and pars plana vitrectomy 2 days before for endophthalmitis, in another hospital. Examination findings included limbal perforation, orbital cellulitis findings, and loss of light perception in the right eye. The patient, who received evisceration surgery and antibiotic treatment, showed loosening of the conjunctival sutures and necrosis in the conjunctiva, tenon, and sclera on the 9th postoperative day. The necrotic tissues were surgically debrided and the patient was referred to HBOT. Results: With HBOT and antibiotherapy, signs of inflammation regressed, healing on the conjunctival surface was accelerated, and prosthesis was suitable for use. Conclusions: Hyperbaric oxygen therapy is a treatment method that plays an active role in the healing of necrotic tissues by increasing the oxygenation and vascularization of the tissue.
... Hyperbaric oxygen therapy (HBOT) has been used to treat blindness, including central retinal artery occlusion, macular Abbreviations: ATA, atmosphere absolute; BCVA, best-corrected visual acuity; FBA, frosted branch angiitis; HBOT, hyperbaric oxygen therapy; OCT, optical coherence tomography; PuR, Purtscher-like retinopathy; ANA, antinuclear antibody. edema due to diabetes, and specific optic neuropathy (4)(5)(6). We report a case utilizing HBOT as a rescue treatment for macular ischemia in post-viral infection-induced FBA and PuR. ...
... Most importantly, according to Henry's law, the amount of dissolved oxygen increases in proportion to the increased partial pressure of oxygen. For instance, if 100% oxygen is breathed at 3 ATA (≈ 2,280 mmHg), dissolved oxygen rises from 0.31 to 6.02 vol%, which theoretically provides sufficient oxygen to maintain the basic metabolism of the human body without oxygen from hemoglobin (6). In an earlier animal study by Landers, the visual evoked response (VER) was restored to normal despite retinal artery occlusion while 1 ATA oxygen was administered. ...
... In an earlier animal study by Landers, the visual evoked response (VER) was restored to normal despite retinal artery occlusion while 1 ATA oxygen was administered. Normal VER indicated that the inner retinal layers were adequately oxygenated in this model (6,11). ...
Introduction
Frosted branch angiitis (FBA) is an uncommon uveitis characterized by fulminant retinal vasculitis. Purtscher-like retinopathy (PuR) is a rare retinal angiopathy associated with a non-traumatic etiology. Both FBA and PuR can cause profound visual impairments.
Case report
We describe the case of a 10-year-old male who presented with sudden bilateral painless visual loss due to FBA with concurrent PuR, with notable viral prodrome 1 month prior to presentation. Systemic investigations revealed a recent herpes simplex virus 2 infection with a high titer of IgM, positive antinuclear antibody (ANA) (1:640), and abnormal liver function tests. After administration of systemic corticosteroids, anti-viral agents, and subsequent immunosuppressive medications, the FBA was gradually alleviated. However, fundoscopy and optical coherence tomography (OCT) revealed persistent PuR and macular ischemia. Hence, hyperbaric oxygen therapy was administered as a rescue strategy, which resulted in gradual bilateral visual acuity improvement.
Conclusion
Hyperbaric oxygen therapy may be a beneficial rescue treatment for retinal ischemia secondary to FBA with PuR.
... The goal of these maneuvers is to lower the intraocular pressure, dilate the occluded artery and allow for the migration of the emboli to a peripheral vessel, preserving central vision [47] . Rebreathing in a brown paper bag for 10 min every 30 min can also increase CO 2 and cause vasodilatation [49] . Methylprednisolone and other intravenous steroids can be used to decrease the retinal edema caused by damage to the cells [11,47] . ...
Dermal fillers have become increasingly popular as a cosmetic treatment for facial rejuvenation. Although these injections are generally considered to be safe, as the number of injections has increased, so has the rate of complications. Ischemic complications of fillers is critical and include vision loss, ophthalmoplegia, skin necrosis, and cerebral infarction. Knowing the anatomy well to optimally prevent and manage these serious complications. Prevention includes knowledge of the vascular anatomy of the facial area, as well as certain injection techniques such as aspiration, use of a smaller needle, and adoption of a larger cannula. The use of ultrasound has been a recent innovation in preventing and treating filler complications as well. The reversibility of fillers should also be considered when choosing a filler. Some hyaluronic acid (HA) fillers, including the newer ones on the market, are difficult to reverse and non-HA fillers and fat are irreversible. This review aims to discuss facial anatomy, the various ischemic filler complications, the prevention and management of these complications, and the relatively recent use of imaging as an adjunct.
... In contrast to normobaric oxygen treatment, hyperbaric oxygen treatment may entail significant dangers [31][32][33][34] , and is possible only for short albeit repeated exposures. The definition of hyperbaric oxygen treatment is the administration of 100% oxygen under increased atmospheric pressure. ...
Oxygen enriched air may increase oxygen pressure in brain tissue and have biochemical effects even in subjects without lung disease. Consistently, several studies demonstrated that normobaric oxygen treatment has clinical benefits in some neurological conditions. This study examined the efficacy of normobaric oxygen treatment in subjects with depression. In a randomized, double-blind trial, 55 participants aged 18-65 years with mild to moderate depression (had a Hamilton Rating Scale for Depression [HRSD] score of ≥ 8) were recruited to the study from the Southern district in Israel. Participants underwent a psychiatric inclusion assessment at baseline and then were randomly assigned to either normobaric oxygen treatment of 35% fraction of inspired oxygen or 21% fraction of inspired oxygen (room air) through a nasal tube, for 4 weeks, during the night. Evaluations were performed at baseline, 2 and 4 weeks after commencement of study interventions, using the following tools: HRSD; Clinical Global Impression (CGI) questionnaire; World Health Organization-5 questionnaire for the estimation of Quality of Life (WHO-5-QOL); Sense of Coherence (SOC) 13-item questionnaire; and, Sheehan Disability Scale (SDS). A multivariate regression analysis showed that the mean ± standard deviation [SD] changes in the HRSD scores from baseline to week four were − 4.2 ± 0.3 points in the oxygen-treated group and − 0.7 ± 0.6 in the control group, for a between-group difference of 3.5 points (95% confidence interval [CI] − 5.95 to − 1.0; P = 0.007). Similarly, at week four there was a between-group difference of 0.71 points in the CGI score (95% CI − 1.00 to − 0.29; P = 0.001). On the other hand, the analysis revealed that there were no significant differences in WHO-5-QOL, SOC-13 or SDS scores between the groups. This study showed a significant beneficial effect of oxygen treatment on some symptoms of depression.
Trial registration: NCT02149563 (29/05/2014).
... The mainstay of therapy for mucormycosis is a combination of surgical debridement of affected tissues and antifungal medication; this is besides eliminating its predisposing factors, such as neutropenia, hyperglycemia, and metabolic acidosis. Some individuals with mucormycosis have received hyperbaric oxygen therapy, although the effectiveness of this treatment has yet to be determined [10]. Interestingly, our patient had hyperbaric oxygen therapy with unclear clinical outcomes as his pain and visual loss failed to improve. ...
Mucormycosis has multiple clinical phenotypes, which are more common in immunocompromised patients, especially those with diabetes mellitus. Debilitating rhino-orbital-cerebral and pulmonary infections by far represent the most typical clinical phenotypes associated with these fungi. Mucormycosis is an uncommon infection; however, there have been isolated sporadic tiny outbreaks around the world. With the substantial increase in COVID-19 cases in India, there is a parallel increase in the number of cases of Mucormycosis. A few reports raising unusual concomitant mucormycosis in COVID-19 patients have raised a possible association between the two diseases.
We report a 59-year-old male with an established history of uncontrolled diabetes mellitus admitted to the hospital with severe COVID-19 pneumonia (severity ascertained according to WHO classification) treated with steroids and discharged home following full recovery. However, one week later, he presented with right eye ophthalmoplegia and complete loss of vision, which was subsequently established as orbital Mucormycosis.
This case highlights the need for heightened awareness of this atypical secondary infection (especially systemic mycosis) in patients recovering from COVID-19 infection.
... 54 According to Butler et al, the best evidence points a success within the initiation of HBOT in 12 hours of the CRAO diagnosis. 50 It has been found that HBOT works best when it is started within 8 hours after the commencement of vision loss, according to researchers Hertzog and colleagues as well as Beiran and colleagues 3,31 HBOT should be commenced within 24 hours of the onset of symptoms, and furtherly it has been observed that results are better if it is done within 12 hours of the onset of symptoms. According to that study, majority of patients who get hyperbaric oxygen within eight hours of acquiring symptoms experience an improvement in visual acuity of three lines or better on the Snellen chart. ...
The central retinal artery occlusion (CRAO) is a rare ophthalmological emergency that can occur in the eye. CRAO can affect persons of any age, however it is most common in people over the age of 60. CRAO is associated with a number of risk factors, including giant cell arteritis, carotid artery atherosclerosis, cardiogenic emboli, hypertension, smoking, diabetes, and thromboembolic disease. The chance of each of these etiologies being present is assessed during the course of the investigation. Hyperbaric oxygen treatment (HBOT) is classified by the American Heart Association for CRAO at level IIb. In accordance with that, HBOT might be considered for the treatment of such a severe condition. HBOT can maintain retinal oxygenation during ischemic events by allowing oxygen to diffuse through choroidal capillaries that have been exposed to elevated partial pressures of oxygen. As a result, ischemia-related damage is reversed if applied within proper time frame. The amount of time that has passed prior to initiation of HBOT is considered to be the most critical factor in determining the best visual prognosis. According to the Undersea and Hyperbaric Medical Society, patients who are identified with CRAO after the onset of symptoms should be evaluated for HBOT within 24 hours. HBOT has the advantage of having a low risk profile, and it can be utilized to improve visual outcomes in proper patients.
... Therefore, a more significant effect of HBOT could possibly have been found if a more intense HBOT regime had been used, as in the present study. Other studies have shown positive but passing effect of HBOT upon DR [36]. In light of this, we found it interesting that our study showed positive effect of HBOT 7 days post HBOT cessation. ...
... This may result in proliferative vitreoretinopathy, which in many cases, progresses to retinal hole formation and retinal detachment (RD). These patients do poorly with scleral buckling procedures to repair their detachments [37] [38]. Approximately 15% of individuals with RD in one eye develop detachment in the fellow eye. ...
