Combined treatment of transluminal Nd:YAG laser embolysis and hyperbaric oxygen for branch retinal artery occlusion

Abstract

Objective: To describe the clinical efficiency of transluminal Nd:YAG laser embolysis (TYE) and hyperbaric oxygen (HBO) as an off-label combined treatment for branch retinal artery occlusion (BRAO) with visible emboli. Methods: A 77-year-old woman had a history of seeing a "shadow" in the lower visual field of the left eye for three days. Platelet-fibrin embolus at the arterial bifurcation was disintegrated by TYE technique and the patient was referred to HBO treatment for 20 sessions. Results: One week after treatment, best-corrected visual acuity improved to 0.8 while a good arterial blood flow in the affected branch was seen. Platelet fibrin plaques had disappeared at fundus, and the pale appearance in the retina had decreased. Conclusions: TYE and HBO combination treatment may be an effective and feasible treatment for restoration of blood flow and vision in BRAO cases caused by visible platelet-fibrin emboli.

Keywords: Nd:YAG laser embolism; branch retinal artery occlusion; hyperbaric oxygen treatment; platelet-fibrin embolism.

Figure 1. a) Color fundus photograph showing a fibrin-platelet embolus (arrow) and opacification of the retina along the superior-temporal vascular arcade;

b) Fluorescein angiogram of the same patient demonstrating a blood flow defect in the affected superior temporal artery

Figure 2. a) Optical coherence tomogram (OCT) demonstrating retinal edema in the superior temporal retinal artery region;

b) OCT image shows improvements of retinal thickening one month following the combined treatment

Figure 3. a) Visual field demonstrating inferior arcuate scotoma;

b) Visual field after the combined treatment showing partial recovery of inferior arcuate scotoma

Figure 4. a) Color fundus photograph one week following TYE and HBO combined treatment;

b) Fluorescein angiogram showing recovery of retinal blood flow