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Partial vision recovery after iatrogenic retinal artery occlusion.

Hsiao SF, Huang YH - BMC Ophthalmol (2014)

Bottom Line: 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.Because no reliable treatments have been reported for such complications, HBOT may be considered as an alternative adjuvant therapy.

View Article: PubMed Central - PubMed

Affiliation: Department of Ophthalmology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, 138 Sheng Li Rd, Tainan, Taiwan. jackhyh@gmail.com.

ABSTRACT

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.

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Related in: MedlinePlus

Multiple emboli along the conjunctival vessels.
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Fig1: Multiple emboli along the conjunctival vessels.

Mentions: A 32-year-old woman sought treatment in the emergency department reporting sudden vision loss in her left eye. Four hours previously, she received vaginal plastic surgery and CaHA filler injection into the glabella region by a local plastic surgeon under general anesthesia. After waking up, she noted vision loss in her left eye, and was immediately transferred to our hospital. The initial best-corrected visual acuity (BCVA) at our emergency department was hand motion at 15 cm in the left eye and 1.0 in the right. The left pupil was dilated with a positive relative afferent papillary defect. There was neither ophthalmoplegia nor strabismus. Slit lamp examination showed multiple emboli along the conjunctival vessels (Figure 1). Fundoscopy in the right eye (OD) revealed normal findings (Figure 2A), while the left eye (OS) showed multiple emboli in the whole choroidal layer (Figure 2B). The corresponding spectral-domain OCT showed normal choroidal vascularity in the right eye (Figure 2C). In the left eye, multiple hyper-reflective depositions, which resulted in dark acoustic shadows (arrow head) in the retinal layer, were found (Figure 2D). Close-up imaging revealed distal RAOs (Figure 2E). Magnetic resonance imaging (MRI) showed no evidence of acute brain infarction, however, there were high-attenuation materials around the glabella region, which were compatible with the CaHA filler injections (Figure 3). Fundus fluorescein angiography (FAG) obtained on the second hospital day showed multiple absences of retinal perfusion in the arteriovenous phase (Figure 4A), and fluorescein leaking out of the occlusive retinal artery was found in the late phase (Figure 4B). Under the diagnosis of iatrogenic RAO, the therapies were administered to shorten the ischemic period on the basis of the European Assessment Group for Lysis in the Eye (EAGLE) guidelines,[5] including topical and systemic intraocular pressure lowering agents, isovolemic hemodilution, globe massage, and anticoagulation with acetylsalicylic acid. In addition, carbogen inhalation and oral corticosteroids were also provided.Figure 1


Partial vision recovery after iatrogenic retinal artery occlusion.

Hsiao SF, Huang YH - BMC Ophthalmol (2014)

Multiple emboli along the conjunctival vessels.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4197310&req=5

Fig1: Multiple emboli along the conjunctival vessels.
Mentions: A 32-year-old woman sought treatment in the emergency department reporting sudden vision loss in her left eye. Four hours previously, she received vaginal plastic surgery and CaHA filler injection into the glabella region by a local plastic surgeon under general anesthesia. After waking up, she noted vision loss in her left eye, and was immediately transferred to our hospital. The initial best-corrected visual acuity (BCVA) at our emergency department was hand motion at 15 cm in the left eye and 1.0 in the right. The left pupil was dilated with a positive relative afferent papillary defect. There was neither ophthalmoplegia nor strabismus. Slit lamp examination showed multiple emboli along the conjunctival vessels (Figure 1). Fundoscopy in the right eye (OD) revealed normal findings (Figure 2A), while the left eye (OS) showed multiple emboli in the whole choroidal layer (Figure 2B). The corresponding spectral-domain OCT showed normal choroidal vascularity in the right eye (Figure 2C). In the left eye, multiple hyper-reflective depositions, which resulted in dark acoustic shadows (arrow head) in the retinal layer, were found (Figure 2D). Close-up imaging revealed distal RAOs (Figure 2E). Magnetic resonance imaging (MRI) showed no evidence of acute brain infarction, however, there were high-attenuation materials around the glabella region, which were compatible with the CaHA filler injections (Figure 3). Fundus fluorescein angiography (FAG) obtained on the second hospital day showed multiple absences of retinal perfusion in the arteriovenous phase (Figure 4A), and fluorescein leaking out of the occlusive retinal artery was found in the late phase (Figure 4B). Under the diagnosis of iatrogenic RAO, the therapies were administered to shorten the ischemic period on the basis of the European Assessment Group for Lysis in the Eye (EAGLE) guidelines,[5] including topical and systemic intraocular pressure lowering agents, isovolemic hemodilution, globe massage, and anticoagulation with acetylsalicylic acid. In addition, carbogen inhalation and oral corticosteroids were also provided.Figure 1

Bottom Line: 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.Because no reliable treatments have been reported for such complications, HBOT may be considered as an alternative adjuvant therapy.

View Article: PubMed Central - PubMed

Affiliation: Department of Ophthalmology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, 138 Sheng Li Rd, Tainan, Taiwan. jackhyh@gmail.com.

ABSTRACT

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.

Show MeSH
Related in: MedlinePlus