Normobaric oxygen therapy for scleral ischemia or melt

Abstract

Purpose: To investigate the efficacy of normobaric oxygen (NBO) therapy for treatment of scleral ischemia or melt.

Methods: This prospective interventional case series includes 9 eyes of 8 patients with scleral ischemia or melt of diverse etiologies. Following the failure of conventional medical and/or surgical therapy to improve ischemia or upon clinical deterioration, NBO was initiated. All patients received 100% NBO at flow rate of 10 liters/minute by face mask for 1 hour, twice daily until complete vascularization of ischemic areas. Main outcome measures were improvement of scleral ischemia and healing of conjunctival epithelial defects.

Results: NBO therapy led to epithelialization and vascularization of the ischemic sclera in all eyes; the repair process began 3-4 days after NBO had been initiated and was completed in 18.1±4.7 (range, 10-25) days. All patients remained stable over a 9-month follow-up period.

Conclusion: NBO therapy seems effective for treatment of scleral ischemia or melt, and hence can be considered as a non-invasive alternative to surgical intervention in these conditions.

Keywords: Oxygen Therapy; Scleral Ischemia or Melt.

Figure 1

(A) Left eye of case #3; scleral ischemia is apparent following conjunctival mass excision. A 12×6 mm area of scleral ischemia which was unresponsive to amniotic membrane transplantation and medical therapy can be observed. (B) Left eye of case 3; note complete vascularization of the ischemic area 25 days after normobaric oxygen therapy.

Figure 2

(A) Right eye of case #4 with history of alkali burn; scleral ischemia can be observed 3 days after normobaric oxygen therapy (12th day post-injury). (B) Right eye of case #4 showed complete healing 14 days after normobaric oxygen therapy.