Hyperbaric Oxygen and The Eye | Print |
 Retinitis Pigmentosa                              

Investigative Ophthalmology 38; 5713 Abstract #3296, 1997
Researchers in Italy are reporting a breakthrough treatment for retinitis pigmentosa with the use of hyperbaric oxygen therapy.  Daily hyperbaric oxygen at 2.2 atmospheres of pressure was employed amont 24 RP patients for two years.  The electroretinogram readings of RP patients undergoing hyperbaric oxygen treatment improved from 4.86 at the beginning of the study to 14.4 at the end of the study.  RP patients who did not undergo oxygen therapy experienced diminished electroretinograms, beginning with an average of 4.92 decreasing to 2.97.  Hyperbaric oxygen therapy may rescue retinal photoreceptors.  This report provides encouraging news to RP patients since there is no proven treatment for RP save for vitamin A therapy which only slows down progressive loss of vision as measured by an electroretinogram and does not improve the ERG.
K.K. Jain, author of The Textbook of Hyperbaric Medicine, indicates the retina has the highest rate of oxygen consumption of any organ in the body.  That hyperbaric oxygen treatment is helpful in cases of RP is an anomaly because it has been shown to cause severe constriction (narrowing) of retinal blood vessels.  The hallmark of RP is poor retinal circulation.  The constriction of the retinal blood vessels however is offset by the greatly increased oxygen carrying capacity of the blood during treatment (oxygen saturation increases by 23 percent.)
Effects of High Oxygen Pressures on the Eye New England Journal of Medicine, Volume 281, pg 25-30, 1969
 Journal French Ophthalmology, Volume 10: 381-86, 1987
Clinical Response of Retinitis Pigmentosa to Hyperbaric Oxygen Therapy
Steigleman WA, Ulrich GG
Department of Ophthalmology, Naval Medical Center, San Diego, CA
Introduction:  Retinitis pigmentosa (RP) is a highly variable degenerative ocular disease involving the progressive death of retinal photoreceptor cells.  Affected patients develop severely reduced peripheral vision, loss of night vision, and often progressive central visual acuity deterioration.  Currently available treatment options are limited and offer modest benefit. Hyperbaric oxygen (HBO) therapy has been reported in selected cases of RP to increase electrical activity in the retina.  It is not known whether this correlates with long-term clinical improvement.  We elected to treat a young RP patient with HBO and assess his clinical response.
Materials and Methods:  A twenty-two year-old male previously diagnosed with RP was selected for this study.  Based upon previously reported methods of treatment (Vingolo et al 1999), the intervention included twenty consecutive HBO sessions using a US Navy Treatment Table 0 (TT9), followed by five consecutive treatments per month for one year.  Clinical parameters including visual acuity, contrast sensitivity, color vision, photostress recovery time, intra-ocular pressure, static perimetry (visual field testing) and electroretinogram (ERG) were recorded at baseline and periodically during the treatment protocol.
Results:  Following the first series of treatments, we observed a modest improvement in best-corrected visual acuity, reduced photo stress recovery time and a doubling of ERG voltage.  By 6 months, ERG voltage had more than tripled from baseline and other improvements were maintained.  The protocol is ongoing. 
Conclusions:  Retinits pigmentosa (RP) is a progressive disease with guarded prognosis and limited treatment options.  Initial results from this study indicate that in some cases of RP, HBO may limit progression and modify some clinical sequelae.  If HBO therapy results in any improvement or at least results in a reduction in the rate of deterioration, it may be possible to develop HBO parameters for minimizing clinical progression in selected patients with RP.
Hyperbaric oxygen treatment has been used as a rescue remedy for optic nerve damage caused by radiation treatment for brain tumors.
Ophthalmology 93; 1083-88, 1986 
Visual Recovery from Radiation, Induced Optic Neuropathy, The Role of Hyperbaric Oxygen Therapy, Borruat, F. X. M.D.; Schatz, N.J.M.D.; Glaser, J.S.M.D.; Feun, L.G.M.D.; Matos, L.M.D.
Abstract:  Optic neuropathy resulting in permanent visual loss is an infrequent delayed complication of radiation therapy.  Hyperbaric oxygen therapy (HBO) has been used to treat such a complication, but its efficacy is controversial.  We report a patient who presented with radiation-induced optic neuropathy 17 months after irradiation for a left maxillary antrum melanoma.  HBO fully reversed visual loss in the more recently involved eye and slightly improved vision in the earlier affected eye.
Hyperbaric Oxygen in the Treatment of Radiation-Induced Optic Neuropathy, Guy J, Schatz NJ, Ophthalmology 1986; 93: 1083-8 (Aug) 
Hyperbaric Oxygen Therapy and Glaucoma 
Hyperbaric oxygen dose of choice in the treatment of glaucoma
Bojic L, Kovacvic H, Andric D, Romanovic D, Petri NM
Department of Ophthalmology, New Hospital, Split, Croatia
Abstract:  The subjects in the study were 111 patients with open angle glaucoma who were submitted to treatment by hyperbaric oxygenation.  Two groups were formed at random, an experimental one of 91 patients and a control group of 20 patients.  The experimental group consisted of four subgroups classified according to the course of treatment they received: 30 sessions (31 patients), 20 sessions (20 patients), 15 sessions (20 patients) and 10 sessions (20 patients).  For the treatment a large walk-in recompression chamber was utilized, once a day at a pressure of 2.0 bars, for 90 minutes.  Visual acuity and mean intraocular pressure values taken before and after hyperbaric oxygen treatment did not show a statistically significant difference either between the treated and control subjects, or at control examinations after three and six months.  During the follow up period, changes in visual field area in control subjects were discrete and statistically not significant.  At the same time the visual field values increased after the therapy in all the subgroups.  In the 10 session course subgroup the increase was not statistically significant.  In all other subgroups, statistical significance was at the level of P < 0.01.  Control after three months demonstrated the same level of statistical significance; control at the end of six months failed to show a statistically significant difference.  The 20 session course is recommended for initial treatment.  When visual field values return to 50 percent of the improved values achieved during initial treatment, it is suggested that hyperbaric oxygen treatment be repeated. 
K.K. Jain, author of Textbook of Hyperbaric Medicine, reports that hyperbaric oxygen has been used to successfully treat cases of glaucoma.  Twenty or more 90 minute treatments at 2 atmospheres of pressure expanded the visual field among all glaucoma subjects tested.  There was no change in eye fluid pressure.  Hyperbaric oxygen therapy and retinal artery and vein occlusion Hyperbaric oxygen treatment combined with a blood-vessel widening drug (vasodilator) has been shown to improve visual function among individuals experiencing retinal artery occlusion. (European Journal Ophthalmology 3; 89-94, 1993)
Hyperbaric Oxygen Treatment of Retinal Artery Occlusion, by Jeffrey N. Weiss, MD, UHM 2010, Vol 37, No 3 
Early Hyperbaric Oxygen Therapy for Retinal Artery Occlusion, Beiran I, Goldenberg I, Adir Y, Tamir A, Shupak A, Miller B, Department of Ophthalmology, Rambam Medical Center, Haifa, Israel  PubMed
Purpose:  To assess whether early hyperbaric oxygenation (HBO) treatment has a beneficial effect on visual results after retinal artery occlusion (RAO).
Methods:  A comparative retrospective study in which medical records of all HBO treated RAO patients in our department were reviewed and compared with matched RAO patients not treated by HBO (from a different medical center).  Mean visual acuity (VA) at completion of treatment, the presence or absence of improvement in VA between admissions and discharge, and the mean change in VA between admission and discharge were noted.  All patients treated by HBO had treatment no later than 8 hours after the beginning of visual symptoms.
Results:  Mean VA at discharge was 0.2981 (6/20) in the treated grip and 0.1308 (6/46) in the control group (p<0.03). In the treated group, 82.9% had an improvement in VA between admission and discharge, compared with 29.7% of the control group (p<0.00001). Mean improvement in VA was 0.1957 in the treated group and 0.0457 in the control group (p<0.01).  Differences in outcome measures between treatment and control group were found to reflect the difference between treated and untreated hypertensive patients.  No difference was found between treated and untreated non-hypertensive patients.
Conclusions:  Early HBO therapy appears to have a beneficial effect on visual outcome in patient with RAO.  Further large scale prospective controlled studies are needed to confirm this. 
Hyperbaric Oxygen and Age-Related Macular Degeneration, by Jeffrey N. Weiss, MD, Retina Associates of South Florida, Margate, FL USA
Introduction:  Age-related macular degeneration (AMD) is the leading cause of visual loss in the elderly in the U.S. and Western Europe.  Approximately 70-80% of severe visual loss, defined as 20/200 or worse vision (legal blindness), is caused by the neovascular type ("wet" AMD) and 20-30% by geographic atrophy ("dry" AMD).  The neovasucular type of AMD may be successfully treated, but there is no effective treatment to slow or halt the progression of geographic atrophy.
Materials and Methods:  Following detailed ophthalmic examination and medical screening, 13 patients ages 79-95 with a history of advanced AMD underwent HBO2.  Eight patients underwent one 60 minute HBO2 session at 1.75 ATA for each of four days.  Five patients were treated at 1.5 ATA each day for six days.
Results:  Each patient experienced an improvement in visual acuity and/or visual field and reported an improvement in their activities of daily living.  No significant difference in outcomes was noted between the patients undergoing four (1.75 ATA) versus six (1.5 ATA) HBO2 treatments.  There were no complications.  The visual improvements, whether in visual acuity or visual field, sometimes occurred subsequent to the treatment and appeared to be maintained at follow-up examinations.
Conclusion:  This group of patients with visual loss from advanced AMD and considered untreatable by presently accepted methods, demonstrated meaningful improvements following a course of HBO2.  There were no complications, and the visual benefit appeared stable at follow up examinations.  Further study is necessary to determine the value of HBO2 in the treatment of advanced AMD.  
Hyperbaric Oxygen Treatment of Non-Acute Central Retinal Artery Occlusion, by Jeffrey Weiss, Retina Associates of South Florida, Margate, Fl USA 
Hyperbaric Oxygen Therapy for Blinding Vascular Occlusions of the Retina (VOR)-- Experience of 201 Cases (206 eyes) Past 20 years, by Inoue O(1), Kajiya S(2), Yachimori R(2), Sawaguchi S(2), (1)Hyperbaric Medicine, (2)Ophthalmology, Ryukyu University Hospital, 270 Uehara Nishihara-cho Okinawa, 903-1225, Japan 
Treatment of Central Retinal Artery Occlusion and Branch Retinal Artery Occlusion by Hyperbaric Oxygen Therapy, by Inoue O(1), Kajiya S(2), Yachimori R(2), Sawaguchi S(2), (1)Hyperbaric Medicine and (2) Ophthalmology, Ryukyu University Hospital, Japan 
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