Hyperbaric Oxygen Therapy for Recalcitrant Macular Edema Following Branch Retinal Vein Occlusion

Abstract

Cystoid macular edema (CME) is the most common cause of reduced vision in branch retinal vein occlusion (BRVO). The treatment protocols for macular edema in BRVO have changed considerably in the previous decade because of the increased popularity of the wide use of optical coherence tomography (OCT) and intravitreal drugs. Intravitreal injection of anti-vascular endothelial growth factors (anti-VEGF) and steroids result in the reduction of CME. However, the effect is transient, and multiple injections may be required. On repeated use, few patients become non-responders to these drugs. Nonetheless, anti-VEGF drugs may have potentially life-threatening complications because of systemic absorption. Intravitreal steroids may lead to severe ocular side effects such as cataract and glaucoma. Chances of endophthalmitis, retinal tear, and inflammation can occur with any of the intravitreal injections. We present a case of BRVO with recalcitrant CME following focal laser, multiple intravitreal anti-VEGF, and steroid injections. However, he had cardiovascular risk factors, so repeated anti-VEGF injections were not given. He was planned for hyperbaric oxygen therapy and showed favorable response. His visual acuity improved and macular edema reduced to more than half from baseline values on OCT.

Keywords

• hyperbaric oxygen therapy
• intravitreal injection
• macular edema
• recalcitrant cystoid macular edema
• retinal vein occlusion