article · Stroke Vascular and Interventional Neurology
Background Retinal artery occlusion (RAO) is a vision‐threatening condition with limited therapeutic options. Hyperbaric oxygen therapy (HBOT) has emerged as a potential treatment to enhance retinal oxygenation and salvage ischemic tissue, though its efficacy and safety remain debated. Methods We followed the Preferred Reporting Items for Systematic reviews and Meta‐Analyses (PRISMA) guidelines and the Cochrane Handbook for Systematic Reviews of Interventions. Databases were searched through November 2024 for studies comparing HBOT with control in RAO patients. Risk of bias was assessed using the Newcastle‐Ottawa Scale (NOS). Meta‐analyses evaluated visual acuity (VA), best‐corrected visual acuity (BCVA), and adverse events (AEs). Results Nine studies with 499 patients (286 HBOT, 213 non‐HBOT) met the inclusion criteria. HBOT was associated with improved BCVA (MD: ‐0.63, 95% CI: [‐1.14, ‐0.12], p=0.01) after sensitivity analysis. No significant differences were observed in uncorrected VA or lines of improvement. AEs included seizures (1.47%), ear barotrauma (1.65%), and epistaxis (0.83%) in the HBOT group. Notably, HBOT was associated with lower rates of neovascular glaucoma (7.89% vs. 15.79%) and stroke (4.3% vs. 16.6%) compared to controls. Conclusions HBOT demonstrates potential for improved visual outcomes in RAO patients, particularly BCVA, with a generally favorable safety profile. However, heterogeneity among studies and limited sample sizes highlight the need for robust prospective trials to clarify its role in RAO management. Highlights Hyperbaric oxygen therapy (HBOT) improves best‐corrected visual acuity (BCVA) in retinal artery occlusion (RAO) patients with a favorable safety profile. Patients receiving HBOT show lower rates of glaucoma (7.89% vs. 15.79%) and stroke (4.3% vs. 16.6%) compared to controls. Further large‐scale prospective trials are needed to validate HBOT's role in RAO treatment due to study variability. image image
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DOI: 10.1161/svi270000_122
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