Branch retinal artery occlusion secondary to high-altitude e
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A 42-year-old man presented with acute, painless visual loss and visual field loss in his left eye. He spent 1 week at high altitude before the descent back, which also took him 1 day by car. The complaints began at a low altitude after the end of his journey. The patient had type II diabetes, which was controlled by insulin for 10 years. He also used metformin for some time. The patient underwent binocular subtotal panretinal photocoagulation for the treatment of DR at 3 months before his journey. Multiple carotid atherosclerotic plaques were shown by the Doppler examination. Increased blood cell counts for white blood cell (WBC), red blood cell (RBC), hemoglobin (HB) and packed cell volume (PCV) were revealed by hematologic examination. Decreased prothrombin time (PT) and increased prothrombin time activity were revealed by hematologic examination.

Best-corrected visual acuity (BCVA) in the right and the left eye were 20/25 and 20/40 (Snellen Chart), respectively. Non-contact intraocular pressure was 17 mmHg in the right eye and 18 mmHg in the left eye. Ophthalmoscopy revealed hemorrhages, cotton wool spots, and laser spots in both eyes. Superficial retinal whitening inferior to the fovea along the distribution of the inferotemporal branch retinal artery was revealed by color fundus photograph of the left eye. Delayed arterial filling corresponding to the area of retinal edema in the early phase and capillary nonperfusion around the optic disc, leakage at the posterior pole in the late phase were revealed by ultra-widefield fluorescein angiography (UWFA).

The HBO treatment, which included daily sessions lasting for 110 min at 2.0 absolute atmospheres, was performed for 10 days. The BCVA in the left eye on the fourth and sixth day of the HBO treatment were 20/33 and 20/25, respectively. On the first day after the end of the HBO treatment, the BCVA in the left eye was 20/20, and it remained unchanged at 1 month after the HBO treatment. Superficial retina whitening of the left eye disappeared, which was revealed by color fundus photograph. The narrowing of the hyper-reflective band and the thinning of the retinal layers were shown in SD-OCT. Central scotomas of the Humphrey visual field had become smaller in the left eye