Use of hyperbaric oxygen therapy as a primary treatment modality of diabetic macular edema

Azza Mohamed Ahmed Said ; Othman Ali Othman Ziko ; Ahmad Aziz Nour El-Din ; Sameeh Ahmed Abd El-Khalek 


Abstract


Purpose: To evaluate the safety and efficacy of hyperbaric oxygen (HBO) therapy as primary treatment modality of clinically significant macular edema (CSME) in diabetic patients. Main outcome measures: Changes in central macular thickness (CMT), decreased leakage on fundus fluorescein angiography (FFA), visual outcome, occurrence of side effects and need for re-treatment. Subjects and Methods: A prospective non-comparative interventional case study included (19) Eyes of 12 diabetic patients who had CSME. They were eligible for HBO therapy at the Egyptian Aerospace Medical Institute (2.4 atmospheric absolute, 40 sessions in total, five sessions per week, the overall time of each session was 90 minutes). Prior treatment full systemic and ophthalmological evaluation was done. Patients were examined clinically, by fundus fluorescein angiography and optical coherence tomography prior to therapy and after four weeks, eight weeks, 12 weeks, 20 weeks and 32 weeks following the start of therapy. Results: Improvement of both mean BCVA and mean CMT was observed and there was a highly statistically significant increase in mean BCVA and decrease in mean CMT when compared to the baseline values at each period of follow up (P-values were ≤ 0.01). 17 out of 19 eyes (89.5%) had benefited from HBO with an average gain of 2.5 lines ±1.0 SD (range: 1.0-4.0) in BCVA. No change of BCVA from baseline till the end of follow up period was noticed in two eyes (10.5%). The mean reduction of CMT from baseline was 149.0 um ± 87.7 (69.0 - 398.0 um). No statistically significant difference was found between eyes with cystoid edema and those with diffuse edema as regards improvement in mean BCVA and mean CMT during the follow up period (P-value > 0.05). There was a highly statistically significant positive correlation between the BCVA (log.MAR) and CMT before and after HBO treatment (r: 0.6, P-value: 0.001). Evidence of increased CMT in four eyes (21.0%) following moderate resolution on OCT was noticed at the end of follow up. This increased macular thickness was associated with reduction in BCVA of (1-2 lines). FFA showed variable changes in response to therapy. At the end of follow up; leakage was disappeared with dry macula in ten eyes (52.6 %). No systemic or ocular complications were encountered with this procedure. Conclusion: HBO therapy was effective and safe primary therapeutic modality of DME in 52.6 % of eyes. Longer duration of follow up and sustained treatment were required. it is advised to do further assessment for this way of treatment for such cases combined with the regimes of treatment present nowadays or for cases that are resistant to the current used procedures as well.


Other data

Keywords hyperbaric oxygen therapy;diabetic macular edema;optical coherence tomography
Issue Date 2010
Publisher Journal of the Egyptian Ophthalmological Society
Source Journal of the Egyptian Ophthalmological Society 2010; 103 (2): 167-176
Journal Journal of the Egyptian Ophthalmological Society 
URI http://research.asu.edu.eg/123456789/955


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