Hyperbaric Oxygen Therapy Versus Intravenous Thrombolysis in the Treatment of Central Retinal Artery Occlusion: A Systematic Review and Meta-Analysis

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 −0.57 logMAR; IVT: MD −0.53 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.