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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

The pathology of a conjunctival biopsy showed several calcified materials (dashed circle) in the capillary lumen. Normal calcifications are not likely and foreign bodies are more likely to be present.
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Fig5: The pathology of a conjunctival biopsy showed several calcified materials (dashed circle) in the capillary lumen. Normal calcifications are not likely and foreign bodies are more likely to be present.

Mentions: Despite the treatment, progressive blurred vision was still found in the following few hours. Intra-arterial fibrinolysis using recombinant tissue plasminogen activator was not performed because of higher rates of adverse side effects[5]. An alternative treatment option, HBOT, was performed. Our patient received 100% oxygen via a face mask at a maximum ambient pressure of 2.5 atmospheres absolute. The protocol for the treatment was 10 minutes of compression, followed by a hyperbaric phase of 60 minutes, and 15 minutes of decompression. The treatment schedule was HBOT 3 times within the initial 24 hours, and 3 more treatments within the following 72 hours, for a total of 6 treatments. Conjunctival biopsy (OS) was performed later, which revealed multiple calcified foreign bodies in the vessel lumens (Figure 5). The visual acuity remained stable after the treatments, and the patient was discharged. Three months after onset, the BCVA improved from hand motion at 15 cm to 0.1 (OD). Fundoscopy in the left eye still showed multiple emboli in retinal vessels (Figure 6). Follow-up fluorescein angiography (FAG) showed improved retinal circulation (Figure 4C) and decreased retinal vessel leakage (Figure 4D).Figure 5


Partial vision recovery after iatrogenic retinal artery occlusion.

Hsiao SF, Huang YH - BMC Ophthalmol (2014)

The pathology of a conjunctival biopsy showed several calcified materials (dashed circle) in the capillary lumen. Normal calcifications are not likely and foreign bodies are more likely to be present.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Fig5: The pathology of a conjunctival biopsy showed several calcified materials (dashed circle) in the capillary lumen. Normal calcifications are not likely and foreign bodies are more likely to be present.
Mentions: Despite the treatment, progressive blurred vision was still found in the following few hours. Intra-arterial fibrinolysis using recombinant tissue plasminogen activator was not performed because of higher rates of adverse side effects[5]. An alternative treatment option, HBOT, was performed. Our patient received 100% oxygen via a face mask at a maximum ambient pressure of 2.5 atmospheres absolute. The protocol for the treatment was 10 minutes of compression, followed by a hyperbaric phase of 60 minutes, and 15 minutes of decompression. The treatment schedule was HBOT 3 times within the initial 24 hours, and 3 more treatments within the following 72 hours, for a total of 6 treatments. Conjunctival biopsy (OS) was performed later, which revealed multiple calcified foreign bodies in the vessel lumens (Figure 5). The visual acuity remained stable after the treatments, and the patient was discharged. Three months after onset, the BCVA improved from hand motion at 15 cm to 0.1 (OD). Fundoscopy in the left eye still showed multiple emboli in retinal vessels (Figure 6). Follow-up fluorescein angiography (FAG) showed improved retinal circulation (Figure 4C) and decreased retinal vessel leakage (Figure 4D).Figure 5

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