ABSTRACT
BACKGROUND: We describe a patient presenting with central retinal artery occlusion (CRAO) of the right eye after retrobulbar anesthesia with adrenaline for macular pucker surgery. CASE PRESENTATION: The patient, a 67-year-old Caucasian man, developed a CRAO postoperatively by the next-day control likely due to the retrobulbar injection of a combination of Xylocaine and Bupivacaine with adrenaline as anesthetic. CONCLUSIONS: The addition of adrenaline to the standard anesthetic solution could be a risk factor for serious complications, such as CRAO.
Subject(s)
Retinal Artery Occlusion , Vitreoretinal Surgery , Aged , Anesthesia, Local/adverse effects , Epinephrine/adverse effects , Humans , Iatrogenic Disease , Male , Retinal Artery Occlusion/chemically inducedABSTRACT
To examine the ocular side effects of selected biological anti-cancer therapies and the ocular and systemic prognosis of patients receiving them. We retrospectively reviewed all medical records of patients who received biological anti-cancer treatment from 1/2012 to 12/2017 and who were treated at our ocular oncology service. The following data was retrieved: primary malignancy, metastasis, type of biological therapy, ocular side effects, ophthalmic treatment, non-ocular side effects, and ocular and systemic disease prognoses. Twenty-two patients received biological therapies and reported ocular side effects. Eighteen patients (81.8%) had bilateral ocular side effects, including uveitis (40.9%), dry eye (22.7%), and central serous retinopathy (22.7%). One patient (4.5%) had central retinal artery occlusion (CRAO), and one patient (4.5%) had branch retinal vein occlusion (BRVO). At the end of follow-up, 6 patients (27.27%) had resolution of the ocular disease, 13 patients (59.09%) had stable ocular disease, and 3 patients (13.64%) had progression of the ocular disease. Visual acuity improved significantly at the end of follow-up compared to initial values. Eighteen patients (81.8%) were alive at study closure. Biological therapies can cause a wide range of ocular side effects ranging from dry eye symptoms to severe pathologies that may cause ocular morbidity and vision loss, such as uveitis, CRAO and BRVO. All patients receiving biological treatments should be screened by ophthalmologists before treatment, re-screened every 4-6 months during treatment, and again at the end of treatment. Patients on biological treatment who have ocular complaints should be urgently referred to ocular consultation for early identification and early intervention.
Subject(s)
Antineoplastic Agents/adverse effects , Biological Therapy/adverse effects , Neoplasms/drug therapy , Adult , Aged , Aged, 80 and over , Antineoplastic Agents/therapeutic use , Biological Therapy/methods , Female , Humans , Male , Middle Aged , Neoplasm Metastasis , Neoplasm Staging , Neoplasms/pathology , Prognosis , Retinal Artery Occlusion/chemically induced , Retinal Artery Occlusion/pathology , Retinal Vein Occlusion/chemically induced , Retinal Vein Occlusion/pathology , Retrospective Studies , Uveitis/chemically induced , Uveitis/pathology , Visual Acuity/drug effectsABSTRACT
Methotrexate is a commonly used agent in the treatment of an un-ruptured ectopic pregnancy. Thromboembolic events are rarely seen side effects of such a medicine. We report the case of the 22-year-old woman who underwent Methotrexate therapy for an un-ruptured ectopic pregnancy without any history of thromboembolic risk factors. A second dose (50 mg/m2) was administered to the patient showing a nondecreasing pattern of ß-HCG levels after an initial standard dosage of Methotrexate (50 mg/m2). On the 12th day of the treatment, a sudden onset of painless vision loss was seen in the right eye. Fundal imaging and fluorescein angiography revealed an occlusion of the superior temporal branch of the right retinal artery. After a month of hyperbaric oxygen therapy, complete recovery without loss of vision was achieved.
Subject(s)
Abortifacient Agents, Nonsteroidal/adverse effects , Methotrexate/adverse effects , Pregnancy, Ectopic/drug therapy , Retinal Artery Occlusion/chemically induced , Chorionic Gonadotropin, beta Subunit, Human/blood , Female , Fluorescein Angiography , Humans , Hyperbaric Oxygenation , Pregnancy , Pregnancy, Ectopic/blood , Retinal Artery Occlusion/diagnostic imaging , Retinal Artery Occlusion/physiopathology , Retinal Artery Occlusion/therapy , Retreatment , Tomography, Optical Coherence , Vision Disorders/etiology , Vision Disorders/physiopathology , Visual Acuity , Young AdultABSTRACT
BACKGROUND: To describe the first case of partial vision recovery in a 32-year-old woman with iatrogenic retinal artery occlusion (RAO) following glabella calcium hydroxylapatite (CaHA) injection, and to explore appropriate diagnostic and therapeutic measures according to a literature review. CASE PRESENTATION: A 32-year-old woman had left eye RAO and a bilateral visual field defect after CaHA injection into the glabella region. Topical and systemic intraocular pressure lowering agents, isovolemic hemodilution, globe massage, and anticoagulation with acetylsalicylic acid were prescribed. Carbogen inhalation and oral corticosteroids were also given. In addition to the above therapies, hyperbaric oxygen therapy (HBOT) was implemented as adjuvant treatment. The final best corrected visual acuity (BCVA) of the left eye improved from hand motion at 15 cm to 0.1. Improved retinal circulation and decreased retinal vessel leakage were found in the follow-up fluorescein angiography. However, there were still multiple emboli in the conjunctival and retinal arteries. CONCLUSION: This is the first case report on partial recovery of BCVA after iatrogenic RAO following cosmetic CaHA injection. Because no reliable treatments have been reported for such complications, HBOT may be considered as an alternative adjuvant therapy.
Subject(s)
Durapatite/adverse effects , Iatrogenic Disease , Recovery of Function/physiology , Retinal Artery Occlusion/chemically induced , Vascular Calcification/etiology , Visual Acuity/physiology , Adult , Anticoagulants/administration & dosage , Antihypertensive Agents/administration & dosage , Biocompatible Materials , Female , Fluorescein Angiography , Glucocorticoids , Hemodilution , Humans , Hyperbaric Oxygenation , Intraocular Pressure , Male , Massage , Retinal Artery Occlusion/physiopathology , Retinal Artery Occlusion/therapy , Tomography, Optical Coherence , Vascular Calcification/physiopathology , Vascular Calcification/therapy , Vision Disorders/chemically induced , Vision Disorders/physiopathology , Vision Disorders/therapy , Visual Fields/drug effects , Visual Fields/physiologyABSTRACT
Cocaine is used to produce a euphoric effect by abusers, who may be unaware of the devastating systemic and ocular side effects of this drug. We describe the first known case of cilioretinal artery occlusion after intranasal cocaine abuse.
Subject(s)
Ciliary Arteries , Cocaine-Related Disorders/complications , Cocaine/poisoning , Retinal Artery Occlusion/chemically induced , Acetazolamide/administration & dosage , Administration, Oral , Diagnosis, Differential , Female , Fluorescein Angiography , Follow-Up Studies , Fundus Oculi , Humans , Infusions, Intravenous , Mannitol/administration & dosage , Massage/methods , Retinal Artery Occlusion/diagnosis , Retinal Artery Occlusion/therapy , Visual Acuity , Visual Field Tests , Visual Fields , Young AdultABSTRACT
BACKGROUND: Severe postoperative loss of vision has been occasionally reported as a rare complication of retrobulbar anesthesia, and several possible causes have been proposed in the literature. In this work, our own and other investigators' experiences with these complications are surveyed with a view to identifying its pathophysiology. PATIENTS: This observational case series refers to six patients who presented during a 3-month period with occlusion of either the central artery itself (n = 3) or a branch thereof (n = 3) 2-14 days after uneventful vitreoretinal surgery following retrobulbar anesthesia with a commercial preparation of mepivacaine (1% Scandicain®, Astra Chemicals, Sweden) containing methyl- and propyl parahydroxybenzoate as preservatives. RESULTS: Three of the patients carried risk factors, which were medically controlled. In three individuals, vasoocclusion was observed after a second vitreoretinal intervention, which was performed 3-12 months after uneventful primary surgery. Good visual recovery was observed in only one instance. CONCLUSIONS: In patients who were anesthetized with preservative-free mepivacaine, no vasoocclusion occurred. In individuals who were anesthetized with mepivacaine containing the preservatives methyl- and propyl parahydroxybenzoate, a tenfold increase in the incidence of eyes requiring re-operation was documented, with a 2- to 14-day lapse in the onset of vasoocclusion. These findings reveal a possible implication of preservatives contained in the local anesthetic solution for the vasoocclusive events. Due to this potential hazard, the use of preservative-free preparations of local anesthesia in ocular surgery is emphasized in order to prevent this sight-threatening complication.
Subject(s)
Anesthetics, Local/adverse effects , Parabens/adverse effects , Preservatives, Pharmaceutical/adverse effects , Retinal Artery Occlusion/chemically induced , Vitrectomy , Aged , Aged, 80 and over , Anesthesia, Local , Anesthetics, Local/administration & dosage , Epiretinal Membrane/surgery , Female , Humans , Male , Mepivacaine/administration & dosage , Mepivacaine/adverse effects , Middle Aged , Orbit , Parabens/administration & dosage , Preservatives, Pharmaceutical/administration & dosage , Retinal Artery Occlusion/diagnosis , Risk Factors , Visual Acuity/physiology , Vitreous Hemorrhage/surgerySubject(s)
Anesthesia, Local/adverse effects , Anesthetics, Local/adverse effects , Retinal Artery Occlusion/chemically induced , Aged , Amides/administration & dosage , Amides/adverse effects , Amides/therapeutic use , Anesthesia, Local/methods , Anesthetics, Local/administration & dosage , Anesthetics, Local/therapeutic use , Animals , Female , Humans , Male , Mepivacaine/administration & dosage , Mepivacaine/adverse effects , Mepivacaine/therapeutic use , Middle Aged , Nerve Block/adverse effects , Nerve Block/methods , Ophthalmologic Surgical Procedures/methods , Rats , RopivacaineABSTRACT
We describe a rare combination of multiple multiple branch retinal arteriolar occlusions (BRAO) and encephalopathy, which developed in an adult male 10 days after smallpox vaccination. A 53-year-old physician presented with sudden temporal visual field loss in the left eye. Ten days earlier he had received a smallpox vaccination. Hyperbaric oxygen was administered because of suspected BRAO. Examination on day 3 revealed a decrease in visual acuity and loss of visual field. Fundoscopy of the left eye disclosed a retinal infarct in the inferior macula and multiple cotton wool spots over the entire posterior pole. Fluorescein angiography showed delayed arterial filling and multiple non-perfused areas. Magnetic resonance imaging of the brain disclosed white matter focal lesions. Neurological examination was normal. Audiological examination revealed mild hearing loss caused by an old phonic trauma. A combination of intravenous methylprednisolone and immunoglobulins, recommended for the treatment of Susac syndrome, was administered. At the follow-up visit 3 months later, visual acuity in the left eye improved, fundoscopy showed resolution of the cotton wool spots and temporal disc pallor, and the visual field was substantially restored.
Subject(s)
Retinal Artery Occlusion/chemically induced , Smallpox Vaccine/adverse effects , Anti-Inflammatory Agents/therapeutic use , Humans , Hyperbaric Oxygenation , Immunoglobulins/therapeutic use , Male , Methylprednisolone/therapeutic use , Middle Aged , Retinal Artery Occlusion/therapyABSTRACT
PURPOSE: To report a case of retinal and choroidal vascular occlusion occurring as a complication after posterior sub-Tenon triamcinolone injection for treatment of uveitic cystoid macular edema. DESIGN: Interventional case report. METHODS: Retrospective study. A 32-year-old woman with uveitis and cystoid macular edema underwent a right posterior sub-Tenon injection of triamcinolone (40 mg/ml, 1 ml total) through a superotemporal approach after topical anesthesia. After the procedure, the patient experienced severe eye pain, orbital ecchymosis, and globe proptosis consistent with retrobulbar hemorrhage. RESULTS: Dilated fundus examination of the right eye (OD) demonstrated multiple intraretinal hemorrhages with particulate white emboli occluding the retinal and choroidal vessels. Visual acuity was no light perception. Ocular massage and hypotensive therapy was initiated for an intraocular pressure of 50 mm Hg. Canthotomy and cantholysis were performed. A total of 39 months post-incident, her visual acuity improved to 20/100. CONCLUSION: Posterior sub-Tenon triamcinolone injection can rarely result in retinal and choroidal occlusion. Immediate intervention may preserve limited visual acuity.
Subject(s)
Choroid Diseases/chemically induced , Choroid/blood supply , Glucocorticoids/adverse effects , Ocular Hypertension/chemically induced , Retinal Artery Occlusion/chemically induced , Triamcinolone/adverse effects , Adult , Antihypertensive Agents/therapeutic use , Choroid/pathology , Choroid Diseases/diagnosis , Fascia , Female , Fluorescein Angiography , Humans , Injections , Intraocular Pressure/drug effects , Macular Edema/complications , Macular Edema/drug therapy , Massage , Ocular Hypertension/drug therapy , Pain/etiology , Retinal Artery Occlusion/diagnosis , Retinal Hemorrhage/chemically induced , Retinal Hemorrhage/diagnosis , Retrospective Studies , Uveitis/complications , Uveitis/drug therapy , Visual AcuityABSTRACT
Visual loss following intranasal injections is extremely rare. A case report of blindness in the only seeing eye after infiltration of the septal mucosa with local anaesthetics and vasopressin is presented. The pathological mechanism and the relationship between different surgical procedures and visual loss are analysed and discussed. Some rules are given to prevent this complication.