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Review
. 2023 Dec 20;13(1):29.
doi: 10.3390/jcm13010029.

Hyperbaric Oxygen Therapy in Ophthalmology: A Narrative Review

Zuzanna Micun  1 , Weronika Dobrzyńska  2 , Michał Sieśkiewicz  1 , Izabela Zawadzka  2 , Diana Anna Dmuchowska  2 , Marzena Wojewodzka-Zelezniakowicz  3 , Joanna Konopińska  2
Affiliations
Review

Hyperbaric Oxygen Therapy in Ophthalmology: A Narrative Review

Zuzanna Micun et al. J Clin Med. .

Abstract

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.

Keywords: acute optic neuropathy; choroidal circulation; hyperbaric oxygen therapy (HBOT); macular edema; retinal artery occlusion.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Color fundus photography and spectral-domain (SD-OCT) of 42-year-old patient with hemiretinal artery occlusion (HRAO) and paracentral acute middle maculopathy (PAMM). The first row shows a color fundus photography illustrating irregular zones of ischemic whitening in the macular region. In the second row of the cross-sectional OCT demonstrating parafoveal inner nuclear layer (INL) hyperreflectivity (green asterisk), the third row demonstrates thickening and hyperreflectivity of the inner and middle retinal layers (green asterisk) indicating the presence of substantial retinal ischemia. Green arrow indicate the area of ischemia.
Figure 2
Figure 2
After 15 days of hyperbaric chamber therapy, the color fundus photography shows reperfusion of the previously mentioned ischemic areas with corresponding OCT images also demonstrating a decrease in retinal thickness and enhancement in morphological parameters of the retina. Green arrow indicate the area of ischemia.
Figure 3
Figure 3
Shows a spectral-domain optical coherence tomography (SD-OCT) and optical coherence tomography angiography (OCTA) of a 56-year-old patient presenting with a combination of cotton wool spot and paracentral acute middle maculopathy (PAMM) as a result of branch retinal artery occlusion (BRAO)). The first row shows an OCT through the parafoveal region, which reveals the inner nuclear layer (INL) hyperreflectivity in a band-like pattern (green asterisk). In the second row, an OCT through the inferior region of macula indicates infarction in the inner retinal layers, cotton wool spot (green asterisk). On the third row, the OCTA shows impaired perfusion in the intermediate capillary plexus (ICP), a component of the deep vascular complex (DVC), temporally from the fovea, corresponding with the PAMM lesion observed on OCT. Green arrow indicate the area of ischemia.
Figure 4
Figure 4
After 15 days of hyperbaric chamber therapy, the OCT reveals a reduction in retinal thickness and OCTA shows improvement in retinal circulation.
See this image and copyright information in PMC

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