Visual impairment by multiple vascular embolization with hydroxyapatite particles

We demonstrate a case of ocular impairment caused by a hydroxyapatite filler injection and review the prior literature on clinical presentations. A healthy woman, who received a hydroxyapatite filler injection into the glabella for nose augmentation suddenly had symptoms of nausea, diplopia, visual loss in the left eye, and impaired consciousness. Her left eye showed paresis of the inferior branch of the oculomotor nerve, conjunctival injection, cell infiltration in the anterior chamber, and multiple white spots in the nasal fundus. Purpura was detected in the area from the glabella to the left forehead. An orbital computed tomography (CT) scan demonstrated high-density deposits along vessels in the left medial orbit and forehead. Although her consciousness stabilized after a few days, the vision in her left eye deteriorated due to corneal edema and both hypopyon and hyphema in the anterior chamber, and the skin from the glabella to the left forehead developed necrosis. Multiple plaques were observed within the conjunctival and scleral vessels. After 2 months, diplopia and visual loss issues were mostly resolved. A histological examination of the conjunctiva specimen showed multiple foreign bodies plugged vessels that could be dissolved by decalcification. Recently, the number of complications by cosmetic filler injections has increased. The migrated hydroxyapatite particles in vessels cause multiple vascular emboli that can lead to various symptoms.     

Spectral domain optical coherence tomography findings of acute branch retinal artery occlusion from calcific embolus

An 82-year-old female presented with sudden painless decrease in vision in the right eye after awakening. She could see the "superior half" of her vision from the right eye only. On examination, best-corrected vision was 20/300 in the right eye and 20/30 in the left eye. The fundus in the right eye revealed recent superotemporal branch retinal artery occlusion (BRAO) with calcified plaque at the disc. Spectral domain optical coherence tomography (OCT) (OTI Ophthalmic Technologies, Inc.), revealed hyperreflectivity and increased thickness of the inner retinal layers of the superior compared to the inferior retina. Imaging at the optic disc revealed the blocked artery containing a highly reflective material. The high reflectivity of the material and underlying optical shadowing could be characterized as calcific emboli.     

Combined cilioretinal artery and hemi-retinal vein occlusion in Sturge Weber syndrome: Expanding the clinical spectrum

A 9-year-old boy with the diagnosis of Sturge-Weber Syndrome, and port-wine stain involving the right side of the face, presented with acute visual loss of the right eye. Examination revealed a high intraocular pressure and a combined cilioretinal artery and inferior hemi-retinal vein occlusion in the right eye. Systemic work-up was negative. After controlling the intraocular pressure, gradual improvement of vision was noticed with simultaneous disappearance of signs of vascular occlusion.     

继发于巨细胞动脉炎的全眼肌麻痹、视神经鞘膜炎和视网膜中央动脉阻塞1例(英文)

一位67岁男性患者出现右边颞侧头痛和右眼视力突发性无痛性丧失,出现这些症状时还伴有全部眼肌麻痹和视盘水肿。ESR和C-反应蛋白升高。核磁共振检查证实有视神经鞘膜炎的特征。右颞侧动脉的活组织切片检查正常。眼外肌运动随着全身激素的应用而好转。不幸的是此后患者右眼发展为中央视网膜动脉阻塞。全眼肌麻痹是巨细胞动脉炎的一种罕见表现,为了得到满意的治疗结果并且阻止对侧眼盲,疾病开始时使用皮质类固醇激素是必要的。     

The central retinal artery occlusion in the right eye followed by a branch retinal artery occlusion in the left eye four days later

A 65-year-old woman was admitted to our clinic with complaints of sudden, painless, decrease in vision, and sectoral visual field defect in the left eye and later presented to our clinic again with a history of sudden loss of vision in her right eye. In this case study we reported that the patient had branch retinal artery occlusion (BRAO) in the left eye and at the same time progressing central retinal artery occlusion (CRAO) in the right eye.     

Therapeutic Intra-arterial Hyaluronidase Infusion for Ophthalmic Artery Occlusion Following Cosmetic Facial Filler (Hyaluronic Acid) Injection

Although dermal/subcutaneous injection of filler into the face is a popular aesthetic surgery, severe complications related to arterial occlusion, including skin necrosis and visual loss, have been reported. Herein, we report a case of intra-arterial hyaluronidase infusion in the ophthalmic artery and other arteries supplying the facial skin following hyaluronic acid injection at the glabella and nasal ala. Despite direct hyaluronidase infusion into the ophthalmic artery, retinal arterial perfusion was not restored, but branches of the ophthalmic and facial arteries were recanalised. Skin discoloration was normalised, and partial recovery of retinal and choroidal perfusion and complete recovery of ocular movement were achieved.     

Retinal artery occlusion in a healthy pregnant patient

PURPOSE: We report a case of branch retinal artery occlusion (BRAO) in a healthy pregnant woman. METHODS: A 29-year-old pregnant woman presented with decreased vision in her left eye. She had a pale retina with macular edema consistent with BRAO. An extensive workup was performed to determine an etiologic factor. All test results were within normal limits except for her factor VIII activity. Her visual acuity improved from finger counting to 20/30 over 2 months without any treatment. RESULTS: This case suggests that BRAO can occur in healthy patients without any systemic or ocular disorders. CONCLUSIONS: BRAO can occur in healthy patients without any systemic or ocular disorders, despite an extensile evaluation.     

Cilioretinal artery occlusion with paracentral acute middle maculopathy associated with COVID-19

The purpose of the study is to describe cilioretinal artery (CILRA) occlusion that is presumed to be associated with COVID-19 without severe respiratory distress and inform ophthalmologists of unusual ocular presentations of COVID-19. Here, we present the first case of a patient with isolated CILRA occlusion and paracentral acute middle maculopathy (PAMM) after recently polymerase chain reaction-proven COVID-19. A 26-year-old female patient presented with a visual field defect in her left eye for 2 days and decreased vision compared to her right eye. It was learned that the patient had a laboratory-proven COVID-19 infection with mild respiratory symptoms that did not require hospitalization 2 weeks ago. Fundus examination revealed retinal edema in the left eye area supplied by the CILRA. Spectral-domain optical coherence tomography revealed a prominent hyperreflective band at the inner nuclear layer level. These findings led us to the diagnosis of isolated CILRA occlusion and PAMM associated with recent COVID-19. CILRA occlusion and PAMM could be associated with the inflammatory and procoagulant condition caused by the SARS-CoV-2 infection.     

Oclusión de la arteria central de la retina como complicación postransfusional de glóbulos rojos

A 32-year-old woman presented with a history of uterine myomatosis and repeated bleeding for 6 months. This produced a haemoglobin concentration of 6.5 g/dL, with a requirement for a red blood cell transfusion. One hour after the transfusion, she presented with a sudden and painless loss of vision in the right eye (RE). As she had no other symptoms, she was referred to the Neuro-Ophthalmology Department. On admission, her corrected visual acuity was hand movement in RE, and 0.6 in the left eye (LE). The anterior segment was unremarkable, except for a relative afferent pupillary defect in RE. In the fundus examination, the RE showed a diffuse pale retina with a cherry spot, consistent with occlusion of the central artery of the retina. Management was attempted but with no improvement. The studies corroborated retinal ischaemia in RE. During the systemic evaluation, the neuroimaging, autoimmune and haematology studies were negative, thus this complication was attributed to the red blood cell transfusion.     

Complete recovery of filler-induced visual loss following subcutaneous hyaluronidase injection

The rise in popularity of hyaluronic acid (HA) dermal filler injection has caused an exceptional increase in the number of cases of reported irreversible blindness. Here, we reported a case of ischemic optic neuropathy and ophthalmoplegia following subcutaneous HA filler injection with complete visual recovery. A 31-year-old Chinese woman presented with sudden onset of right monocular visual impairment associated with diplopia. Patient had received a hyaluronic acid-containing ?ller injection for nasal dorsum augmentation twelve hours prior to presentation. Visual acuity of the right eye was counting finger. A right relative afferent pupillary defect was demonstrated with ophthalmoplegia. Humphrey visual field test disclosed a right inferior altitudinal field defect with impairment of colour vision. Computed tomography of the orbit revealed mild enlargement of the right medial and inferior recti muscles. Our patient showed a tremendous improvement of vision after a subcutaneous hyaluronidase injection with complete visual recovery within 2 weeks.     

A case of central retinal artery occlusion after chiropractic manipulation of the neck

Here we report a case of central retinal artery occlusion after chiropractic manipulation on the neck. A 49-year old man presented at the hospital because of sudden visual loss in his right eye after chiropractic neck manipulation. He had received chiropractic manipulation of the neck by a chiropractor eight days prior. When he first visited us, his best corrected visual acuity in his right eye was hand motion. A full ophthalmic examination was performed. There was cherry-red spot in the macula in his right eye. We performed a fluorescein angiogram and cervical color Doppler. The arterio-venous transit time in the fluorescein angiogram was delayed, and we detected stenosis of the right internal carotid artery with diffuse atherosclerotic plaques in the right common carotid artery. We prescribed ginko biloba extract (Tanamin). Three years after his first visit, the best corrected visual acuity of his right eye was 20 / 200.     

Sudden-onset Blindness from a Spontaneous Carotid-cavernous Fistula with Secondary Central Retinal Artery Occlusion and Posterior Ischemic Optic Neuropathy

Our case describes a patient diagnosed with a carotid-cavernous fistula (CCF) secondary to a spontaneously ruptured cavernous carotid aneurysm, presenting with sudden vision loss, and a concomitant central retinal artery occlusion as visualized by a cherry-red spot in the macula and posterior ischemic optic neuropathy. Computed tomography of the brain and orbits showed mild hydrocephalus, orbital fat haziness, and proptosis with concern for fluid in the basal cisterns. Cerebral angiography confirmed the suspected diagnosis of CCF. After angiography, a Magnetic resonance imaging of the brain demonstrated abnormal diffusion restriction in the posterior right optic nerve confirmed on the apparent diffusion coefficient map, consistent with ischemia of the optic nerve in this location. Two weeks after discharge, outpatient fundus photography showed resolution of her cherry-red spot, and optical coherence tomography showed thinning of the entire retinal nerve fiber layer as compared to the contralateral eye. In CCFs, congestive symptoms of proptosis, pain, and even central retinal vein occlusion findings are frequently described. However, our patient’s no light perception vision and imaging findings suggest associated central retinal artery occlusion and ischemic optic neuropathy. These findings underscore the multitude of serious visual effects of high flow CCFs.     

Edema de papila y obstrucción de arteria y vena central de la retina como manifestación inicial de una recaída leucémica

Clinical caseA 39-year-old man with Philadelphia chromosome-positive acute lymphoblastic leukemia (LAL Ph+) developed progressive vision loss to no light perception in his right eye. He had optic disk edema and later developed central artery and vein occlusions. Pan-photocoagulation, as well as radiotherapy of the whole brain were performed in several fractions. Unfortunately the patient died of hematological relapse 4 months later.DiscussionOptic nerve infiltration may appear as an isolated sign of a leukemia relapse, even before a hematological relapse occurs. Leukemic optic neuropathy is a critical sign, not only for vision, but also for life, and radiotherapy should be immediately performed before irreversible optic nerve damage occurs.     

The Operation Was a Success, but the Patient Cannot See

A 71-year-old African American woman presented with severe vision loss in her left eye one day following trabeculectomy with mitomycin C and retrobulbar anesthesia. She had a new left relative afferent pupillary defect and macular whitening. The optic disc appeared normal. Intraocular pressure and fluorescein angiography were normal. Westergren erythrocyte sedimentation rate and C-reactive protein were elevated. Temporal artery biopsy was positive for giant cell arteritis.     

Oclusión de la arteria central de la retina como complicación oftalmológica luego de un accidente ofídico

Snakebite causes 421,000 - 1,200,000 poisonings per year due to hematotoxicity, neurotoxicity and vasculotoxicity. Ophthalmological manifestations secondary to snake bites are rare. If the snake belongs to the Viperidae family, the most frequent ophthalmologic manifestations are macular infarction, chronic open-angle glaucoma, and retinal or vitreous hemorrhage. Central retinal artery occlusion is an extremely rare ocular complication. We report the case of a 30-year-old patient, who consulted due to poor vision in her left eye weeks after suffering a snake bite (Bothrops atrox) in her left lower limb. The diagnosis was a central retinal artery occlusion in the left eye with abnormal findings in the ophthalmological physical examination and in complementary retinal and neuro-ophthalmological tests.     

Cilioretinal artery occlusions following embolization of an artery to an intracranial meningioma

Purpose To report a case in which a prophylactic embolization of a feeder artery to an intarcranial meningioma led to an occlusion of a cilioretinal artery. Design A case report. Methods A 48-year-old man with an intracranial meningioma presented with ocular pain and visual loss in his right eye following embolization of a feeder artery to the meningioma with polyvinyl alcohol. Results Ophthalmoscopy 1 month later showed a cilioretinal artery occlusion which was confirmed by fluorescein angiography. His visual acuity was 0.01 in the right eye. The patient was not treated for his ocular symptoms, and his visual acuity 9 month postoperatively improved slightly to 0.1. Conclusions Our case demonstrated that an occlusion of a retinal artery can be a complication of preoperative embolization of an artery to an intracranial tumor and can lead to severe visual loss.     

Oclusión coexistente de vena y arteria central de la retina en un paciente con psoriasis en tratamiento con ustekinumab

A 44 year-old Caucasian male with a history of plaque psoriasis currently being treated with ustekinumab presented with sudden loss of vision in his left eye. Fundus examination showed central retinal vein occlusion coexisting with central retinal artery occlusion. Posterior examination revealed mild polycythemia, being the underlying cause unknown.     

复方樟柳碱治疗视网膜中央动脉阻塞40例

目的比较复方樟柳碱球后注射联合颞浅动脉旁注射与单纯颞浅动脉旁注射治疗视网膜中央动脉阻塞对其视力、视野等影响的差别,评价其对视网膜中央动脉阻塞的疗效。方法观察2005年10月至2007年10月20例20眼采用复方樟柳碱球后注射联合颞浅动脉旁注射的治疗组与20例20眼单纯颞浅动脉旁注射治疗的对照组视网膜中央动脉阻塞患者的视力、视野变化,并进行对照分析。结果复方樟柳碱球后注射联合颞浅动脉旁注射与单纯颞浅动脉旁注射有效率进行比较分析,用药后7 d和用药后14 d治疗组与对照组比较,差异有统计学意义,在提高视力,改善视野上,2组差异有统计学意义。结论应用复方樟柳碱球后注射联合颞浅动脉旁注射治疗视网膜中央动脉阻塞是一种有效的治疗方法。     

Branch retinal artery occlusion in a child

Background: Retinal artery occlusive events are unusual in the paediatric population. The average age of their occurence is 60 years and the aetiology most often related to cardiovascular disease.
Case Report: A healthy 11-year-old white girl developed permanent unilateral visual field loss as a result of a branch retinal artery occlusion. An extensive work-up included transthoracic and transoesophageal echocardiograms, routine haematological and biochemical testing including serum lipids, screening for thrombophilia and thrombolysis, as well as autoantibodies, all of which proved to be within normal limits.
Conclusions: Recognition of the underlying aetiology is not always possible, but should be sought as prognosis for vision or survival may rest upon these findings.     

Retinal branch artery occlusion following injection of hyaluronic acid (Restylane)

The authors report a retinal branch artery occlusion occurring after facial injection of a dermal filler. The superior temporal artery showed occlusion due to a clearly visible long and fragmented embolus suggestive of gel and clearly distinguishable from calcific or cholesterol emboli. The authors suppose that hyaluronic acid gel was embolized in the patient. The embolized material is supposed to enter the ocular circulation through retrograde arteriolar flow after intra-arterial injection into one of the peripheral branches of the ophthalmic artery. If there is any evidence of a visual problem after facial injection of a dermal filler, prompt consultation of an ophthalmologist is recommended.