TREATMENT OF DISC EDEMA AND RETINAL ARTERY OCCLUSION WITH HBOT DURING THE THIRD TRIMESTER OF PREGNANCY
Swaby K, Valderrama O, Schiffman J, Smith L, Fife C
Memorial Hermann Center for Hyperbaric Medicine, Houston, TX, the Dept. Anesthesiology, The University of Texas Medical School at Houston, TX, and Neuro-Eye Diagnostics, Houston, TX
BACKGROUND:
HBO has been used with documented clinical success in the treatment of cerebral edema and ocular ischemia (retinal artery and vein occlusion), perhaps due to the unique combination of reduced blood flow and increased tissue oxygen levels occurring during hyperbaric therapy.
CASE HISTORY:
A 26-year-old Hispanic female, non-smoker, G1P0 at 27 weeks gestation suffered a transverse sinus thrombosis with resulting bilateral disc edema associated with bilateral visual loss which was unresponsive to steroids. After bilateral optic nerve sheath fenestrations, retina of the left was noted to be pale and retinal artery occlusion was diagnosed. She was referred for HBOT with 20/400 vision, 4 days after fenestration surgery, approximately 3 weeks after symptom onset. She underwent 7 HBO treatments at 2.0 ATA for 90 minutes, not more than once per day. She was able to read very large letters at a distance of 12 inches during treatment with sustained improvement despite some decrement in the hours after removal from the chamber. Incremental improvement in vision was noted with each subsequent treatment. Fetal movements remained good. She later delivered a healthy term infant.
CONCLUSIONS:
There are numerous case reports (~130/350 benefitted/total reported) in the world literature supporting the possible benefit of HBOT in retinal artery syndromes. Many pregnant women have been treated with HBOT for carbon monoxide poisoning, usually with a single treatment. HBOT has purportedly been used for placental insufficiency in some countries, but published information on these results is limited. There is no evidence that HBOT causes premature closure of the ductus arteriosus. This case supports previous observations that in certain serious medical conditions, even a series of treatments in the final trimester produces no obvious fetal harm.
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