Major ozone therapy improves disease severity without affecting retinal microvascular parameters in fibromyalgia syndrome: an observational pre-post study

This study aimed to assess the impact of ten sessions of major ozone therapy on disease severity and ophthalmologic parameters in patients with fibromyalgia syndrome (FMS). This observational study was conducted in the Physical Medicine and Rehabilitation and Ophthalmology clinics of a tertiary healthcare facility. The study involved 30 patients diagnosed with FMS who underwent 10 weekly sessions of major ozone therapy. Symptom severity was measured before and after treatment using the Fibromyalgia Impact Scale (FIQ). The study assessed ophthalmic parameters, including visual acuity, spherical equivalent, astigmatism, axis, intraocular pressure, and central corneal thickness. Additionally, microvascular changes were examined using optical coherence tomography angiography (OCTA). Post-treatment, FIQ scores decreased significantly (before: 67.19 ± 14.02; after: 46.78 ± 11.46; p < 0.001), indicating a notable reduction in symptom burden. The mean intraocular pressure was measured at 15.25 ± 2.67 mmHg before treatment and 15.41 ± 3.55 mmHg after treatment, while central corneal thickness was recorded as 530.50 ± 19.35 μm and 531.50 ± 19.21 μm. Superficial capillary plexus foveal vascular density was found to be 14.98 ± 7.16% before treatment and 15.34 ± 7.62% after treatment. Best-corrected visual acuity remained 1.0 ± 0.0 in both assessments. Spherical equivalent was - 0.05 ± 1.05 D pre-treatment and - 0.01 ± 1.03 D post-treatment (p = 0.380), and astigmatism was - 0.64 ± 0.60 D and - 0.64 ± 0.54 D (p = 0.100). Foveal avascular zone area (0.333 ± 0.129 vs. 0.331 ± 0.133 mm²; p = 0.732), total foveal retinal thickness (213 vs. 214 μm; p = 0.253), and deep capillary plexus foveal vascular density (30.07 ± 8.44% vs. 30.18 ± 8.18%; p = 0.786) also remained stable. No statistically significant differences were observed in anterior segment parameters, intraocular pressure, central corneal thickness, or retinal microvascular structures as measured by OCTA (p > 0.05). Ten sessions of major ozone therapy effectively reduced symptom burden in FMS patients, though short-term changes in the anterior segment and retinal microvascular structures were not measurable. Ozone therapy may serve as a complementary and supportive approach alongside existing treatments for managing FMS.