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Gesell LB, Trott A. De Novo cataract development following a standard course of Hyperbaric Oxygen Therapy. Undersea Hyperb Med 2007; 34(6):389-392. A 49 y/o female under went 48 hyperbaric oxygen (HBO2) treatments at 2.5 ATA (atmospheres absolute) (253 kPa) for 90 minutes for chronic refractory osteomyelitis of the sacrum and recurrent failure of a sacral myocutaneous flap. Prior to HBO2 therapy, formal ophthalmic exams revealed myopia but no evidence of cataract formation. Eight weeks following the completion of HBO2 therapy, on repeat ophthalmic exam, the patient was discovered to have worsening myopia. Changes of the crystalline lens, consistent with nuclear cataract development, were identified in each eye. Other common causes of cataract formation including diabetes, corticosteroid use, and excessive exposure to ultraviolet light, were excluded. While transient visual changes are known to occur during HBO^sub 2^ therapy, cataract formation has only rarely been reported and only after prolonged courses of treatment (150 or more treatments). This case identifies the need to further investigate the ocular effects of HBO^sub 2^ therapy, especially with regard to cataract development and progression.
INTRODUCTION
Hyperbaric Oxygen (HBO2) delivered under standard protocols is known to cause visual changes most commonly in the form of transient myopia (1,2). Refractive changes can be measured by as early as 4 weeks, or 20 treatments (1,3). Following treatment, myopia resolves but may take up to 4 months or longer (4). More serious complications, cataracts, can be induced under experimental HBO^sub 2^ conditions, but have rarely been reported in humans (5,6). In the reported human cases, cataracts developed only after prolonged HBO^sub 2^, 150 treatments or more (7). With the maximum number of individual HBO2 treatments in the United States ranging from 60 to 75, de novo cataracts have not been reported (8). We report the first case of a patient with documented clear lenses on an exam prior to HBO^sub 2^ who developed bilateral nuclear cataracts 8 weeks after undergoing 48 treatments.
CASE REPORT
A 49 year old female with sacral osteomyelitis and recurrent failure of a myocutaneous flap was treated with a course of HBO^sub 2^ therapy. Medical history was significant for hypertension, asthma, and scleroderma with minor manifestations. Other causes of cataracts including diabetes, corticosteroid use, and excessive exposure to ultraviolet...