First Author: D.Lopes PORTUGAL
Co Author(s): S. Parreira S. Barros I. Machado F. Vinagre N. Campos
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To report a rare clinical case of a bilateral arteritic central retinal artery occlusion (CRAO) responsive to a combined treatment with corticosteroid and hyperbaric oxygen (HBO) therapy.
Hospital Garcia de Orta, Almada, Portugal
A 74-year-old man presented to our urgent care service with a chief complaint of sudden painless vision loss of the left eye lasting 12 hours. The patient also referred acute visual loss of the right eye one day before, headache and scalp tenderness. His active problems include transient ischaemic attack, dyslipidemia, hypertension, diabetes mellitus and ischaemic heart disease. The visual acuity measurement showed light perception in both eyes. Ophthalmic examination revealed a cherry-red spot in the centre of the macula of both eyes, compatible with the diagnosis of a bilateral CRAO. Laboratorial studies revealed elevated levels of erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP).
The patient immediately started high-dose (first intravenous and then oral) corticosteroid therapy and HBO therapy. Ten days after starting the treatment, the patient underwent ultrasound examination of both temporal arteries that showed the hypoechogenic halo sign. The clinical presentation, the laboratorial and imaging studies support the diagnosis of CRAO secondary to giant cell arteritis. The ESR and CRP levels dropped to normal values after 1 week of treatment and after 2 weeks, he had a visual acuity of 1/10 in the left eye, without improvement of the right eye.
According to some studies, early HBO therapy appears to have a beneficial effect on visual outcome in patients with CRAO. Hyperbaric oxygen treatment may also be a safe and effective adjunct treatment of corticosteroid therapy for patients with CRAO due to giant cell arteritis. Our case is an example of how an early diagnosis and prompt combined steroid and hyperbaric oxygen therapy can increase the chance of visual improvement.