Slowing the degenerative process, long lasting effect of hyperbaric oxygen therapy in retinitis pigmentosa
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Retinitis pigmentosa (RP) therapy is still an unsolved challenge. Recent reports have underlined that hyperbaric oxygen (HBO) therapy could play a role in slowing the retinal degenerative process. The aim of this study was to assess the efficacy of HBO therapy on visual function in RP patients.
We performed a single-center, comparative, longitudinal case-controlled randomized clinical trial, which lasted 10 years. We randomly divided RP patients into two groups. Group 1, the control group, consisted of 44 RP patients (21 males and 23 females; mean age 35.5) who took Vitamin A. Group 2, with 44 RP patients (21 males and 23 females; mean age 35,02), underwent HBO therapy. No statistically significant difference was found at the beginning of the study between the two groups. We compared the results concerning visual acuity, Goldmann perimetry, static perimetry Humphrey field analyzer (HFA), and electroretinogram (ERG) obtained in the two groups at 5 and 10 years follow-up. Statistical analysis was performed with Kaplan-Meier life-table with the evaluation of log-rank coefficient.
At 5 year follow-up, 87.5% of group 2 patients preserved 80% of the initial visual acuity, while the same result was achieved in only 70.4% of group 1 patients (X2 = 8.2; p < 0.01); at 10 year follow-up, 63.33% of group 2 patients preserved 80% of the initial visual acuity, while the same percentage of residual visual acuity was maintained in 40% of group 1 patients (X2 = 3.22; p = 0.05). At 10 year follow-up, Goldmann perimetry (target I4e) did not change in 31.6% of group 2 and in 10.5% of group 1; evaluation of mean defect (MD) with static perimetry HFA showed that 53% of HBO patients had 80% of residual mean sensitivity compared to 23.5% of the control group patients (X2 = 4.72; p = 0.035). ERG b-wave mean values at the end of the protocol were significantly higher in the HBO treated group (X2 = 4.53; p = 0.013).
Our study underlines that HBO therapy can be a safe alternative approach to RP patients, contributing to the stabilization of their visual function concerning visual acuity, visual field, and ERG responses while waiting for a definite cure.
KeywordsRetinitis pigmentosa Hyperbaric oxygen therapy Retina
- 1.Marmor MF, Aguirre G, Arden G, Berson EL (1983) Retinitis pigmentosa symposium on terminology and methods of examination. Ophthalmology 90:126–131Google Scholar
- 2.Berson EL (1993) Retinitis pigmentosa. The Friedenwald lecture. Invest Ophthahlmol Vis Sci 34:1659–1676Google Scholar
- 6.Weinstein GW, Mannemmee AE, Hyvarinen L (1971) On the pathogenesis of retinitis pigmentosa. Ophtalmologica 65:82–97Google Scholar
- 8.Pannarale L, Forte R, Amodeo S, Pierazzi MC (1993) Retinitis pigmentosa clinical and epidemiological aspects. Boll Ocul 783–788Google Scholar
- 9.Pannarale MR (1992) Clinical introduction to retinitis pigmentosa. Proceedings of the Workshop on RP, Rome, Italy, March 1991Google Scholar
- 12.Marmor MF, Arden GB, Nilsson SE, Zrenner E (1989) Standard for clinical electroretinography. Arch Ophthalmol 107:816–819Google Scholar
- 15.Stone J, Maslim J, Valter K, Mervin K (1996) The influence of oxygen levels on the death and survival of photoreceptors. In: Anderson RE (ed) Retinal degeneration in degenerative diseases of the retina. Plenum Press, New York, USA, pp 371–377Google Scholar
- 16.Rispoli E, Verde AM, De Marco G, Vingolo EM, Mucci A (1988) Modificazioni elettrofisiologiche oculari dell’insufficienza respiratoria cronica. Clin Ocul e Patol Ocul IX:393–397Google Scholar
- 19.Stryer L (1991) Visual excitation and recovery. J Biolog Chem 266:10711–10714Google Scholar
- 24.Verin PH, Compte P, Poisot D (1986) Retinite pigmentaire et oxygenotherapie hyperbare. Bull Soc Opht Fran LXXXVI:1071–1074Google Scholar
- 25.Skogstad M, Bast Pettersen R et al (1994) Treatment with hyperbaric oxygen. Illustrated by the treatment of a patient with retinitis pigmentosa. Tidssk Nor Laegeforen 114:2480–2483Google Scholar
- 27.Hori S (1982) Study on hyperbaric oxygen. Induced convulsion with particular reference to GABA in synaptosomes. J Biochem 9:443–452Google Scholar