Comparative efficacy of conservative, hyperbaric oxygen, and endovascular retinal surgery approaches in central retinal artery occlusion

PurposeTo assess and compare the efficacy of three treatment modalities for central retinal artery occlusion (CRAO): conservative therapy, hyperbaric oxygen therapy (HBOT), and endovascular retinal surgery (ERS).Patients and methodsWe retrospectively analyzed the cases of CRAO patients treated at the Toyama University Hospital. Their age range was 44-87 years; a balanced gender distribution was observed. The conservative therapy group included 13 eyes (6 males, 7 females, average age 74 years). HBOT group: 11 eyes from 10 patients (5 males, 5 females, average age 70 years). ERS group: 10 eyes (7 males, 3 females, average age 74 years). The treatments were as follows. Conservative group: ocular massage and sublingual nitroglycerin. HBOT: 60-min sessions at 2 atmospheres. ERS: vitrectomy followed by tissue plasminogen activator injection using a 47-ga. microneedle. Visual acuity was assessed using logMAR units, with statistical analyses by paired t-test, Kruskal-Wallis test, and Mann-Whitney U-test with Bonferroni correction.ResultsThe conservative group showed a slight visual acuity change from 1.96 +/- 0.53 to 1.88 +/- 0.56 (p = 0.56). The HBOT group exhibited a significant improvement from 1.79 +/- 0.80 to 1.28 +/- 0.81 (p = 0.007). The ERS group displayed the most substantial improvement, with scores moving from 1.98 +/- 0.36 to 0.68 +/- 0.49 (p = 0.0000413). The ERS group's outcomes were significantly superior to those of the other groups.ConclusionThese results suggest that while conservative treatment may not be sufficient, both HBOT and endovascular retinal surgery show promise, with the latter demonstrating the most significant improvement.