Author: Tea Caljkusic-Mance
Co-authors: Tamara MiSljenović Vučerić, Zvjezdana Alpeza Dunato, Goran Pelčić, Maja Novak
Abstract
PURPOSE: To show succesfull clinical effects of transluminal Nd YAG laser embolysis (TYE) support by hyperbaric oxygen therapy (HBOT) as an combined treatment for some cases of retinal artery occlusion (RAO) with visible emboli.SETTING: Eye Clinic; University Hospital Center Rijeka
METHODS: 3 patients in last 2 years presented to our clinic and were diagnosed RAO.They underwent best corrected visual acuity (BCVA) testing, biomicroscopy, dilated fundus indirect ophtalmoscopy, intraocular pressure (IOT) measuring, fundus photography (FF), OCT and fluorescein angiography (FA) if it was possible.TYE was applied directly to the arterial segment embedding the embolus using a three mirrors Goldman lens.The spot diameter was constant 50 µ in size and the power ranged from 0.5 mJ to 2.0 mJ. We need 1-2 sessions with 2-5 shots.After TYE procedure HBOT was started with one session per day for a total of 20 sessions (2.4 ATA for 120 min)
RESULTS: After TYE and 20 session HBOT procedure best-corrected visual acuity improved as follows: from 0.2 to 0.5, from 0.4 to 0.9 and from hand motions to 0.3, while a better arterial blood flow in the affected branches were seen.
Emboli had mostly disappeared at fundus, and the pale appeareance in the retina had decreased.
CONCLUSIONS: Number of treatment options are avaliable for RAO, but there is no definitive treatment (antiglaucoma drugs, paracentesis,systemic antifibrinolitic agents, intra-retinal fibrinolysis, surgical embolectomy, TYE and HBOT as monotherapy.TYE for RAO resulted in prompt visual improvement besides capillary reperfusion. Photodisruption of emboli has been found to be related with fast restoration of retinal blood flow and improvement of vision. Some studies have reported HBOT as an effective treatment in RAO. Hyperoxia caused by HBOT may induce recovery of the retina and macula oxygenation and keep retina cells alive
By combining treatments we sought to elicit a synergistic effect. The results of our cases caused the satisfactory visual improvement following combined TYE and HBOT treatment in patients with RAO. Even that combined treatment is an off-label modality it may be considered in RAO cases caused by visible emboli. TYE and HBOT combination may be an effective treatment for restoration of blood flow and vision
In all cases the risk of TYE must be weighed against the possibility of severe and permanent loss of vision secondary to RAO.
STATE FINANCIAL DISCLOSURE: No
