Recupero
The addition of hyperbaric oxygen therapy to standard treatment improved visual acuity and reduced corneal oedema in patients with keratoendotheliosis.
Clinical Bottom Line: 1. Hyperbaric oxygen therapy is associated with improved visual acuity and reduced corneal oedema in patients with keratoendotheliosis. 2. Hyperbaric oxygen therapy was associated with a lower risk of corneal neovascularization secondary to keratoendotheliosis. Appraised by: Mike Bennett,Dept of Diving and Hyperbaric Medicine,Prince of Wales Hospital,Sydney; Wednesday, 20 January, 1999
Clinical Scenario: A 75 year old patient who developed secondary keratoendotheliosis following cataract extraction. Three-part Question: In patients developing keratoendotheliosis following cataract surgery, does the administration of hyperbaric oxygen, in addition to standard care, result in reduction of corneal oedema or improvement in visual acuity? Search Terms: Hyperbaric oxygenation, Cataract extraction/complications.
The Study: Non-blinded randomised controlled trial with intention-to-treat. Patients with keratoendotheliosis secondary to surgical treatment where there was no evidence of direct endothelial irritation. Control group (N = 21; 21 analysed): Local corticosteroids, hypertonic saline, antibiotics and autohaemotherapy. Epithelial stimulators locally if ulcer present. Systemic diuretics, vitamins, magnesium and potassium salts. Experimental group (N = 12; 12 analysed): As above plus hyperbaric oxygen at 2ATA for 90 minutes daily for 10 days.
The Evidence:
| Outcome | Time to Outcome | Control rate | HBO rate | Relative risk reduction | Absolute risk reduction | NNT |
| visual acuity not improved | 10 days | 0.76 | 0.17 | 78% | 0.6 | 2 |
| 95% CI: | 41% to 100% | 0.31 to 0.87 | 2 to 4 | |||
| corneal width not reduced | 10 days | 0.81 | 0.5 | 38% | -0.31 | 3 |
| 95% CI: | -2% to 79% | -0.02 to 0.64 | NNT2 to INF NNH53 to INF | |||
| Corneal oedema not reduced | 10 days | 0.76 | 0.33 | 57% | 0.43 | 3 |
| 95% CI: | 14% to 99% | 0.12 to 0.75 | 2 to 10 | |||
| Corneal neovascularization | 10 days | 0.24 | 0 | 100% | 0.24 | 4 |
| 95% CI: | 0.06 to 0.42 | 2 to 18 |
Comments: 1. Poor randomisation with allocation of those not fit for hyperbaric therapy to the control arm threatens the validity of this study. 2. No follow-up beyond end of treatment period. 3. No functional clinical outcome is given, making the impact of the differences noted difficult to assess.
Expiry date: April 2021 References: 1. Recupero SM, Cruciani F, Picardo V, Sposato PA, Tamanti N, Abdolrahimzadeh S. Hyperbaric oxygen therapy in secondary keratoendotheliosis. Annals of Ophthalmology 1992; 24:448-452.
