Hyperbaric Oxygen Therapy and Visual Outcomes in Retinal Artery Occlusion: A Retrospective 24-Year Cohort Study

Abstract Purpose To evaluate the association between hyperbaric oxygen therapy (HBOT) and visual outcomes in patients with acute non-arteritic retinal artery occlusion (RAO) managed according to a predefined institutional treatment protocol. Methods This retrospective cohort study included consecutive patients with central (CRAO) or branch retinal artery occlusion (BRAO) treated at a tertiary referral center between 2000 and 2023. Comparative analyses were restricted to protocol-consistent patients who met institutional HBOT eligibility criteria based on presentation within 8 hours of symptom onset. Visual outcomes were compared between HBOT-treated and standard-management groups. Multivariable linear regression was used to evaluate the association between HBOT and final visual acuity (VA) and change in VA (ΔVA) after adjustment for baseline clinical characteristics. Results The analytic cohort comprised 181 patients (125 CRAO and 56 BRAO), including 106 treated with HBOT and 75 managed without HBOT. Baseline VA was significantly worse in HBOT-treated patients. Final VA did not differ significantly between treatment groups in unadjusted analyses. However, HBOT-treated patients demonstrated greater visual improvement in both CRAO (ΔVA − 0.77 vs − 0.19 logMAR; P = 0.007) and BRAO (ΔVA − 0.76 vs − 0.07 logMAR; P < 0.001). After multivariable adjustment, HBOT remained independently associated with better final VA and greater visual improvement in both CRAO and BRAO. Conclusion In this retrospective protocol-based cohort, HBOT was independently associated with improved visual outcomes in patients with acute non-arteritic RAO despite poorer baseline vision. These findings support further prospective multicenter studies and randomized trials to clarify the therapeutic role of HBOT.