Combined Treatment of Hyperbaric Oxygen and Anti-vascular Endothelial Growth Factor Therapy in Cilioretinal Artery Occlusion Associated With Central Retinal Vein Occlusion

We report a case of a male in his early 40s who presented with transient episodes of visual blurring and was initially diagnosed with isolated cilioretinal artery occlusion (CLRAO). Hyperbaric oxygen therapy (HOT) was initiated on the same day as the onset of the preceding episode, and six sessions had been completed when he was first examined at our department. Despite ongoing HOT, he developed worsening signs of venous stasis. Further investigation confirmed CLRAO secondary to central retinal vein occlusion (CRVO) and revealed heterozygosity for the factor V Leiden mutation. HOT was continued for two weeks, and a single intravitreal injection of bevacizumab (anti-vascular endothelial growth factor (anti-VEGF)) was administered, resulting in full and sustained anatomical and functional recovery, with visual acuity improving from 8/10 to 10/10. This case supports the benefit of anti-VEGF therapy in combined CLRAO and CRVO without exudative or neovascular complications, by promoting vasoconstriction and reducing venous permeability. It also suggests a synergistic effect with HOT by further lowering retinal venous pressure through distinct mechanisms. These findings highlight the potential benefit of addressing both retinal hypoxia and venous hypertension through the combined use of HOT and anti-VEGF therapy in selected cases of mixed retinal vascular occlusion.