{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,30]],"date-time":"2026-03-30T13:17:02Z","timestamp":1774876622903,"version":"3.50.1"},"reference-count":45,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2026,3,30]],"date-time":"2026-03-30T00:00:00Z","timestamp":1774828800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100008136","name":"National Institute of Health","doi-asserted-by":"publisher","award":["P30-EY025585"],"award-info":[{"award-number":["P30-EY025585"]}],"id":[{"id":"10.13039\/100008136","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Central retinal artery occlusion (CRAO) causes sudden, often profound monocular vision loss. We compared the efficacy and safety of hyperbaric oxygen therapy (HBOT) versus intravenous thrombolysis (IVT) using a systematic review and meta-analysis. Methods: Following PRISMA 2020 guidance, we searched PubMed, Cochrane Library, Web of Science, and VHL from inception to 27 May 2025, screened records in duplicate, and synthesized visual outcomes (best-corrected visual acuity [BCVA], logMAR), onset-to-treatment time, and adverse events using random-effects models. Results: Twenty-five observational studies (781 patients; 557 HBOT eyes, 225 IVT eyes) met inclusion. Both HBOT and IVT were associated with significant improvements in BCVA (HBOT: MD \u22120.57 logMAR; IVT: MD \u22120.53 logMAR). Clinically meaningful improvement occurred in 45.8% after HBOT and 42.0% after IVT. Adverse event rates were similar (HBOT 11.3%; IVT 10.2%) but differed in type (ear barotrauma with HBOT; hemorrhagic events with IVT). Conclusions: HBOT and IVT both improve visual outcomes in CRAO. Differences in adverse event profiles and substantial heterogeneity among IVT studies underscore the need for adequately powered comparative trials and standardized treatment pathways. Registration: Not prospectively registered; PRISMA 2020 checklist is provided.<\/jats:p>","DOI":"10.3390\/jcm15072628","type":"journal-article","created":{"date-parts":[[2026,3,30]],"date-time":"2026-03-30T12:11:44Z","timestamp":1774872704000},"page":"2628","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Hyperbaric Oxygen Therapy Versus Intravenous Thrombolysis in the Treatment of Central Retinal Artery Occlusion: A Systematic Review and Meta-Analysis"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-7388-0688","authenticated-orcid":false,"given":"Anas","family":"Bakdalieh","sequence":"first","affiliation":[{"name":"College of Medicine, Northeast Ohio Medical University, Rootstown, OH 44272, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dawood","family":"Siddiqui","sequence":"additional","affiliation":[{"name":"College of Medicine, Northeast Ohio Medical University, Rootstown, OH 44272, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3199-8665","authenticated-orcid":false,"given":"Ding-Geng","family":"Chen","sequence":"additional","affiliation":[{"name":"College of Health Solutions, Arizona State University, Phoenix, AZ 85004, USA"},{"name":"Department of Statistics, University of Pretoria, Pretoria 0002, South Africa"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Minzhong","family":"Yu","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology and Visual Sciences, University Hospitals Eye Institute, Case Western Reserve University, Cleveland, OH 44106, USA"},{"name":"Cole Eye Institute, Cleveland Clinic Foundation, Cleveland, OH 44106, USA"},{"name":"Department of Ophthalmology, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH 44195, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,3,30]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"P259","DOI":"10.1016\/j.ophtha.2019.09.028","article-title":"Retinal and Ophthalmic Artery Occlusions Preferred Practice Pattern","volume":"127","author":"Flaxel","year":"2020","journal-title":"Ophthalmology"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"P270","DOI":"10.1016\/j.ophtha.2024.12.024","article-title":"Retinal and Ophthalmic Artery Occlusions Preferred Practice Pattern\u00ae","volume":"132","author":"Kovach","year":"2025","journal-title":"Ophthalmology"},{"key":"ref_3","first-page":"e282","article-title":"Management of Central Retinal Artery Occlusion: A Scientific Statement From the American Heart Association","volume":"52","author":"Schrag","year":"2021","journal-title":"Stroke"},{"key":"ref_4","unstructured":"American Heart Association (2019). Inclusion and Exclusion Criteria for IV Thrombolytic Treatment of Ischemic Stroke (Professional Toolkit), American Heart Association."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"581","DOI":"10.1161\/STR.0000000000000086","article-title":"Scientific Rationale for the Inclusion and Exclusion Criteria for Intravenous Alteplase in Acute Ischemic Stroke","volume":"47","author":"Demaerschalk","year":"2016","journal-title":"Stroke"},{"key":"ref_6","unstructured":"Tripathy, K., Shah, S.S., and Waymack, J.R. (2025). Central Retinal Artery Occlusion. StatPearls, StatPearls Publishing."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"273","DOI":"10.4103\/2211-5056.353126","article-title":"A Review of the Management of Central Retinal Artery Occlusion","volume":"12","author":"Madike","year":"2022","journal-title":"Taiwan J. Ophthalmol."},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Roskal-Wa\u0142ek, J., Ruzik, A., Kubi\u015b, N., Teper, M., Weso\u0142owski, M., Wujec, Z., Wa\u0142ek, P., Odrobina, D., Mackiewicz, J., and Wo\u017cakowska-Kap\u0142on, B. (2024). Therapeutic Strategies for Retinal Artery Occlusion\u2014A Literature Review. J. Clin. Med., 13.","DOI":"10.3390\/jcm13226813"},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Ma, Q., Chu, C., and Song, H. (2015). Intravenous versus Intra-Arterial Thrombolysis in Ischemic Stroke: A Systematic Review and Meta-Analysis. PLoS ONE, 10.","DOI":"10.1371\/journal.pone.0116120"},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Ortega, M.A., Fraile-Martinez, O., Garc\u00eda-Montero, C., Callej\u00f3n-Pel\u00e1ez, E., S\u00e1ez, M.A., \u00c1lvarez-Mon, M.A., Garc\u00eda-Honduvilla, N., Monserrat, J., \u00c1lvarez-Mon, M., and Bujan, J. (2021). A General Overview on the Hyperbaric Oxygen Therapy: Applications, Mechanisms and Translational Opportunities. Medicina, 57.","DOI":"10.3390\/medicina57090864"},{"key":"ref_11","first-page":"253","article-title":"Side Effects of Hyperbaric Oxygen Therapy","volume":"41","author":"Camporesi","year":"2014","journal-title":"Undersea Hyperb. Med. J. Undersea Hyperb. Med. Soc. Inc."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1825","DOI":"10.1007\/s00415-021-10838-6","article-title":"Intravenous Thrombolysis in Patients with Central Retinal Artery Occlusion: A Systematic Review and Meta-Analysis","volume":"269","author":"Huang","year":"2022","journal-title":"J. Neurol."},{"key":"ref_13","first-page":"e41878","article-title":"Intravenous Thrombolysis for Central Retinal Artery Occlusion: A Look at the Literature for the Emergency Medicine Physician","volume":"15","author":"Webb","year":"2023","journal-title":"Cureus"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1007\/s11936-022-00973-2","article-title":"Intravenous Thrombolytics in the Treatment of Acute Ischemic Stroke","volume":"25","author":"Alhadid","year":"2023","journal-title":"Curr. Treat. Options Cardiovasc. Med."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"2018","DOI":"10.1161\/STROKEAHA.119.028743","article-title":"Intravenous Fibrinolysis for Central Retinal Artery Occlusion: A Cohort Study and Updated Patient-Level Meta-Analysis","volume":"51","author":"Nackenoff","year":"2020","journal-title":"Stroke"},{"key":"ref_16","unstructured":"Chen, D.-G., and Peace, K. (2021). Applied Meta-Analysis with R and Stata, Chapman & Hall\/CRC. [2nd ed.]."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"419","DOI":"10.1007\/s10792-024-03335-y","article-title":"Comparative Efficacy of Conservative, Hyperbaric Oxygen, and Endovascular Retinal Surgery Approaches in Central Retinal Artery Occlusion","volume":"44","author":"Akai","year":"2024","journal-title":"Int. Ophthalmol."},{"key":"ref_18","unstructured":"Coelho, P.A. (2018). Hyperbaric Oxygen in CRAO\u2014Our Experience. Rev. Soc. Port. Oftalmol., 42."},{"key":"ref_19","first-page":"180","article-title":"Efficacy of HBOT in Central Retinal Artery Occlusion: Visual Outcome","volume":"5","author":"Gupta","year":"2019","journal-title":"Ophthalmol. Allied Sci."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"23676","DOI":"10.1038\/s41598-024-71895-1","article-title":"A Comprehensive Evaluation of Efficacy of Hyperbaric Oxygen Therapy in Non-Arteritic Central Retinal Artery Occlusion Using Enhanced Depth Imaging Optical Coherence Tomography","volume":"14","author":"Lee","year":"2024","journal-title":"Sci. Rep."},{"key":"ref_21","first-page":"e66196","article-title":"Effects of Hyperbaric Oxygen Therapy in the Treatment of Patients With Central Retinal Artery Occlusion: A Retrospective Study","volume":"16","author":"Maldonado","year":"2024","journal-title":"Cureus"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1261","DOI":"10.1038\/s41433-021-01617-8","article-title":"Hyperbaric Oxygen Treatment for Non-Arteritic Central Retinal Artery Occlusion Retrospective Comparative Analysis from Two Tertiary Medical Centres","volume":"36","author":"Rozenberg","year":"2022","journal-title":"Eye"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1080\/01658107.2023.2290536","article-title":"Thrombolytic Therapy for Central Retinal Artery Occlusion in an Academic Multi-Site Stroke Centre","volume":"48","author":"Alhayek","year":"2024","journal-title":"Neuro-Ophthalmology"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"2229","DOI":"10.1161\/STROKEAHA.111.613653","article-title":"Efficacy of Intravenous Tissue-Type Plasminogen Activator in Central Retinal Artery Occlusion: Report From a Randomized, Controlled Trial","volume":"42","author":"Chen","year":"2011","journal-title":"Stroke"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"123441","DOI":"10.1016\/j.jns.2025.123441","article-title":"Safety of Intravenous Thrombolysis in Central Retinal Artery Occlusion Patients with Concomitant Acute Cerebral Infarctions","volume":"471","author":"Jubran","year":"2025","journal-title":"J. Neurol. Sci."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"2322","DOI":"10.1161\/STROKEAHA.115.009839","article-title":"Retrobulbar Spot Sign Predicts Thrombolytic Treatment Effects and Etiology in Central Retinal Artery Occlusion","volume":"46","author":"Nedelmann","year":"2015","journal-title":"Stroke"},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Schultheiss, M., H\u00e4rtig, F., Spitzer, M.S., Feltgen, N., Spitzer, B., H\u00fcsing, J., Rupp, A., Ziemann, U., Bartz-Schmidt, K.U., and Poli, S. (2018). Intravenous Thrombolysis in Acute Central Retinal Artery Occlusion\u2014A Prospective Interventional Case Series. PLoS ONE, 13.","DOI":"10.1371\/journal.pone.0198114"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"107610","DOI":"10.1016\/j.jstrokecerebrovasdis.2024.107610","article-title":"IV Thrombolysis for Central Retinal Artery Occlusion\u2014Real-World Experience from a Comprehensive Stroke Center","volume":"33","author":"Stretz","year":"2024","journal-title":"J. Stroke Cerebrovasc. Dis."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"956","DOI":"10.1136\/bjo-2023-323972","article-title":"Efficacy and Safety of Hyperbaric Oxygen Therapy Monitored by Fluorescein Angiography in Patients with Retinal Artery Occlusion","volume":"108","author":"Chiabo","year":"2024","journal-title":"Br. J. Ophthalmol."},{"key":"ref_30","first-page":"495","article-title":"Efficacy and Safety of a Standardized Hyperbaric Oxygen Therapy Protocol for Retinal Artery Occlusion","volume":"49","author":"Kauert","year":"2022","journal-title":"Undersea Hyperb. Med. J. Undersea Hyperb. Med. Soc. Inc."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"102204","DOI":"10.1016\/j.ajoc.2024.102204","article-title":"A Telemedicine-Enabled Intravenous Thrombolytic Treatment Pathway for Patients with Hyperacute Non-Arteritic Central Retinal Artery Occlusion","volume":"36","author":"Gilbert","year":"2024","journal-title":"Am. J. Ophthalmol. Case Rep."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"700","DOI":"10.1016\/j.ajo.2008.06.016","article-title":"Intravenous Thrombolysis With Low-Dose Recombinant Tissue Plasminogen Activator in Central Retinal Artery Occlusion","volume":"146","author":"Hattenbach","year":"2008","journal-title":"Am. J. Ophthalmol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"393","DOI":"10.1016\/j.ajo.2024.09.027","article-title":"Outcomes of Hyperbaric Oxygen Treatment for Central Retinal Artery Occlusion: A Single Center Experience","volume":"269","author":"Kim","year":"2025","journal-title":"Am. J. Ophthalmol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"20505","DOI":"10.1038\/s41598-023-47987-9","article-title":"Long-Term Outcomes of Intravenous Fibrinolysis in Central Retinal Artery Occlusion","volume":"13","author":"Kozner","year":"2023","journal-title":"Sci. Rep."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"425","DOI":"10.22462\/07.08.2021.7","article-title":"Treatment Outcomes on Neovascularization after CRAO Treated with Hyperbaric Oxygen","volume":"48","author":"Lifson","year":"2021","journal-title":"Undersea Hyperb. Med. J. Undersea Hyperb. Med. Soc. Inc."},{"key":"ref_36","first-page":"9765938","article-title":"Hyperbaric Oxygen Therapy in Retinal Arterial Occlusion: Epidemiology, Clinical Approach, and Visual Outcomes","volume":"2019","author":"Lopes","year":"2019","journal-title":"Case Rep. Ophthalmol. Med."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"783","DOI":"10.1097\/ICB.0000000000000895","article-title":"Case Series of Hyperbaric Oxygen Therapy for Central Retinal Artery Occlusion","volume":"15","author":"Masters","year":"2021","journal-title":"Retin. Cases Brief Rep."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"891","DOI":"10.1007\/s00415-022-11439-7","article-title":"Thrombolysis in Central Retinal Artery Occlusion: A Retrospective Observational Study","volume":"270","author":"Raber","year":"2023","journal-title":"J. Neurol."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"224","DOI":"10.28920\/dhm53.3.224-229","article-title":"Outcomes of Hyperbaric Oxygen Treatment for Central and Branch Retinal Artery Occlusion at a Major Australian Referral Hospital","volume":"53","author":"Williamson","year":"2023","journal-title":"Diving Hyperb. Med."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"108240","DOI":"10.1016\/j.jstrokecerebrovasdis.2025.108240","article-title":"Visual Outcomes of Central Retinal Artery Occlusion: Exploring Treatment Strategies beyond the Conventional Time Window","volume":"34","author":"Yang","year":"2025","journal-title":"J. Stroke Cerebrovasc. Dis."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"603","DOI":"10.1007\/s10654-010-9491-z","article-title":"Critical Evaluation of the Newcastle-Ottawa Scale for the Assessment of the Quality of Nonrandomized Studies in Meta-Analyses","volume":"25","author":"Stang","year":"2010","journal-title":"Eur. J. Epidemiol."},{"key":"ref_42","unstructured":"Le Noan, L. (2021). Time Is Eye!. Eur. Stroke Organ., Available online: https:\/\/eso-stroke.org\/timeiseye\/."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"894","DOI":"10.1016\/S1474-4422(25)00352-7","article-title":"Treatment of Acute Central Retinal Artery Occlusion: Light at the End of the Tunnel?","volume":"24","author":"Biousse","year":"2025","journal-title":"Lancet Neurol."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"3065","DOI":"10.1167\/iovs.12-11445","article-title":"Systemic Prostaglandin E1 to Treat Acute Central Retinal Artery Occlusion","volume":"54","author":"Takai","year":"2013","journal-title":"Investig. Ophthalmol. Vis. Sci."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"n71","DOI":"10.1136\/bmj.n71","article-title":"The PRISMA 2020 statement: An updated guideline for reporting systematic reviews","volume":"372","author":"Page","year":"2021","journal-title":"BMJ"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/7\/2628\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,30]],"date-time":"2026-03-30T12:17:39Z","timestamp":1774873059000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/7\/2628"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,30]]},"references-count":45,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2026,4]]}},"alternative-id":["jcm15072628"],"URL":"https:\/\/doi.org\/10.3390\/jcm15072628","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,30]]}}}