Relationship between age-adjusted Charlson comorbidity index and ischemic stroke in patients with ophthalmic artery occlusion or retinal artery occlusion / 中华眼底病杂志

Objective:To investigate the relationship between age-adjusted Charlson comorbidity index (aCCI) and ischemic stroke in patients with ophthalmic artery occlusion (OAO) or retinal artery occlusion (RAO).Methods:A single center retrospective cohort study. Seventy-four patients with OAO or RAO diagnosed by ophthalmology examination in Shenzhen Second People's Hospital from June 2004 to December 2020 were included in the study. The baseline information of patients were collected and aCCI was used to score the patients' comorbidity. The outcome was ischemic stroke. The median duration of follow-up was 1 796.5 days. According to the maximum likelihood ratio of the two-piecewise COX regression model and the recursive algorithm, the aCCI inflection point value was determined to be 6, and the patients were divided into low aCCI group (<6 points) and high aCCI group (≥6 points). A Cox regression model was used to quantify the association between baseline aCCI and ischemic stroke.Results:Among the 74 patients, 53 were males and 21 were females, with the mean age of (55.22±14.18) (19-84) years. There were 9 patients of OAO and 65 patients of RAO. The aCCI value ranges from 1 to 10 points, with a median of 3 points. There were 63 patients (85.14%, 63/74) in the low aCCI group and 11 patients (14.86%, 11/74) in the high aCCI group. Since 2 patients could not determine the time from baseline to the occurrence of outcome events, 72 patients were included for Cox regression analysis. The results showed that 16 patients (22.22%, 16/72) had ischemic stroke in the future. The baseline aCCI in the low aCCI group was significantly associated with ischemic stroke [hazard ratio ( HR)=1.76, 95% confidence interval ( CI) 1.21-2.56, P=0.003], and for every 1 point increase in baseline aCCI, the risk of future ischemic stroke increased by 76% on average. The baseline aCCI in the high aCCI group had no significant correlation with the ischemic stroke ( HR=0.66, 95% CI 0.33-1.33, P=0.247). Conclusions:aCCI score is an important prognostic information for patients with OAO or RAO. A higher baseline aCCI score predicts a higher risk of ischemic stroke, and the association has a saturation effect.

Analysis of ocular complications caused by injection of facial cosmetic / 局解手术学杂志

Objective To analyze the anatomic factors of the central retinal artery occlusion or the ophthalmic artery occlusion after the injection of facial cosmetic surgery.Methods Retrospectively analyzed 3 patients who occurred severely ocular complications just after facial cosmetic injection in last 2 years.The diagnosis of central retinal artery occlusion was confirmed by fundus examination and fundus fluoresce-in angiography.Analysis the blood vessel distribution of the injection site and characteristics of peri-orbit vascular anastomosis.Results All the 3 cases presented no light perception,with eye pain or (and)the eyeball pain.The fundus test and fundus fluorescein angiographies showed central retinal artery obstruction.Facial cosmetic injection pressure significantly exceeded the ophthalmic artery systolic pressure 2 seconds after injection (P <0.05).Dorsal nasal artery and angular artery were anastomotic,and the angular artery was usually anastomotic with lateral nasal branches of the posterior ciliary artery.The filler can enter the ophthalmic artery by the branches of the anastomosis,which can make ophthalmic artery occlusion,central retinal artery occlusion or get occlusion of their branches.Conclusion The injectant may get into the orbital artery and retrograde to the ophthalmic artery,which resulting in ophthalmic artery occlusion,or get into central retinal artery and posterior ciliary artery,which resulting in serious ocular complications.

Multiple Cerebral Infarctions with Neurological Symptoms and Ophthalmic Artery Occlusion after Filler Injection

PURPOSE: To report a case of visual loss, side weakness and facial palsy due to ophthalmic artery occlusion with diffuse multiple cerebral infarctions after injection of hyaluronic acid. CASE SUMMARY: A 50-year-old female visited our clinic for visual loss in the left eye after filler injection in the glabella. Her best corrected visual acuity was 1.0 in the right eye and hand motion in the left eye. The intraocular pressure was 8 mm Hg in the right eye and 14 mm Hg in the left eye. In the left eye, there was abnormal pupillary light reflex and complete extra-ocular muscles palsy with blepharoptosis. A pale retina with a cherry-red-spot also appeared in the left fundus. A central retinal artery occlusion was observed on fluorescein angiography and brain magnetic resonance imaging showed multiple cerebral infarctions at the frontal, temporal, parietal and occipital lobes. Four days later, the motor weakness was aggravated and dysarthria and aphasia became worse. According to symptoms, a hemorrhagic transformation in subacute infarctions developed based on brain computed tomography. After 3 months of follow up, the visual acuity in the left eye was no light perception. However, the general conditions including ophthalmoplegia and motor weakness were improved.

Ophthalmic Artery Occlusion After Carotid Revascularization

Distal embolization resulting from carotid angioplasty and stenting (CAS) occurs mainly in the cerebral hemisphere. We report a case of ophthalmic artery occlusion after carotid revascularization. A 75-year old man received emergency CAS for cervical internal carotid artery occlusion. Two months later, the patient was readmitted for decreased visual acuity. We found ophthalmic artery occlusion that was not noticed soon after CAS. Although ophthalmic artery occlusion after CAS is rare, endovascular neurosurgeons should be aware of this potential complication.

Ophthalmic Artery Occlusion With Third Cranial Nerve Paresis Associated With Acute Internal Carotid Artery Occlusion

PURPOSE: We report a case of ophthalmic artery occlusion with third nerve paresis in the left eye due to acute occlusion of the left ICA. CASE SUMMARY: A 37-year-old man visited our emergency room with "black out" in the left eye, headache, and nausea. The corrected visual acuity was 20/25 in the right eye, and hand motion in the left eye. In the left eye, a relative afferent papillary defect was noted, with an intraocular pressure of six mmHg. Twenty prisms of exotropia in the primary position was observed, and ocular motor examination revealed limitations of supraduction, infraduction, and adduction in the left eye, suggesting third nerve palsy of the left eye. Fundus examination revealed a pale retina in the macula of the left eye. Brain MRI demonstrated multifocal faint low densities in the left caudate nucleus as well as the frontal and parietal lobes. CT angiography and four-vessel angiography demonstrated complete occlusion in the proximal part of the left internal carotid artery ICA.

An Incidental Finding of Pseudoexfoliation in Patient With Ophthalmic Artery Occlusion

PURPOSE: To report a case of pseudoexfoliation in the unaffected eye in a patient with ophthalmic artery occlusion. CASE SUMMARY: A 49-year-old female presented with sudden vision loss in her right eye. On the initial examination, best corrected visual acuity was 20/500 in the right eye, and 20/20 in the left eye. Intraocular pressure in both eyes was 17 mmHg. Fundus examination showed retinal edema and a cotton wool spot in the right eye. There was a filling delay of choroidal and retinal vessels in the fluorescein angiography. On the slit lamp examination, there was pseudoexfoliation material around the pupil margin and lens capsule in the unaffected eye but no evidence of glaucoma. At the six-month follow-up, best corrected visual acuity in the right eye improved to 20/30 and a retinal nerve fiber layer defect was found at the spot of the previous cotton wool spot. On the visual field examination, visual defects corresponded with a retinal nerve fiber layer defect. CONCLUSIONS: Pseudoexfoliation may be related to a systemic vascular disorder.

Bilateral Ophthalmic Artery Occlusion in Rhino-Orbito-Cerebral Mucormycosis

PURPOSE: To report a case of bilateral ophthalmic artery occlusion in rhino-orbito-cerebral mucormycosis. METHODS: Reviewed clinical charts, photographs, and fluorescein angiography RESULTS: An 89-year-old man with poorly controlled diabetes developed sudden bilateral ptosis, complete ophthalmoplegia of the right eye, and superior rectus palsy of the left eye. Brain and orbit magnetic resonance imaging showed midbrain infarction and mild diffuse sinusitis. On the 2nd day of hospitalization, sudden visual loss and light reflex loss developed. There were retinal whitening, absence of retinal arterial filling, and a total lack of choroidal perfusion on fluorescein angiography of the right eye. The left eye showed a cherry red spot in the retina and the absence of retinal arterial filling and partial choroidal perfusion on fluorescein angiography. On rhinologic examination, mucormyosis was noticed. Despite treatment, visual acuity and light reflex did not recover and he died 4 days after admission. CONCLUSIONS: Bilateral ophthalmic artery occlusion can occur in rhino-orbital-cerebral mucormycosis.

Bilateral Ophthalmic Artery Occlusion in Rhino-Orbito-Cerebral Mucormycosis

PURPOSE: To report a case of bilateral ophthalmic artery occlusion in rhino-orbito-cerebral mucormycosis. METHODS: Reviewed clinical charts, photographs, and fluorescein angiography RESULTS: An 89-year-old man with poorly controlled diabetes developed sudden bilateral ptosis, complete ophthalmoplegia of the right eye, and superior rectus palsy of the left eye. Brain and orbit magnetic resonance imaging showed midbrain infarction and mild diffuse sinusitis. On the 2nd day of hospitalization, sudden visual loss and light reflex loss developed. There were retinal whitening, absence of retinal arterial filling, and a total lack of choroidal perfusion on fluorescein angiography of the right eye. The left eye showed a cherry red spot in the retina and the absence of retinal arterial filling and partial choroidal perfusion on fluorescein angiography. On rhinologic examination, mucormyosis was noticed. Despite treatment, visual acuity and light reflex did not recover and he died 4 days after admission. CONCLUSIONS: Bilateral ophthalmic artery occlusion can occur in rhino-orbital-cerebral mucormycosis.

Two Cases of Ocular Ischemia following Scleral Encircling

PURPOSE: To report two cases of ocular ischemia following scleral encircling. METHODS: A 21-year-old man with glaucoma and a 76-year-old woman without any medical problem were transferred to our department for surgery to treat retinal detachment. After retrobulbar anesthesia and limbal peritomy of conjunctiva, the 4-rectus muscles were isolated. Scleral encircling was performed with No. a 42 band (4.0 mm in width) after cryotherapy done completely around retinal tear. RESULTS: Following surgery, One patient experienced ophthalmic artery occlusion and while the other patient experienced central retinal artery occlusion. Vision was not restored in either cases despite IV injection of 250 ml of 15% mannitol solution and anterior chamber paracentesis. CONCLUSIONS: In the cases where patients are of old age or suffer from glaucoma, we strongly recommend that the surgeons perform the scleral encircling carefully.

A Case of Ophthalmic Artery Occlusion in Moyamoya Disease

PURPOSE: We report a case of ophthalmic artery occlusion at Moyamoya disease. METHOD: A 64-year-old man who had followed up neurosurgical clinic after diagnosed with Moyamoya disease ten months before presented with sudden visual loss in his right eye. Generalized ophthalmic examinations including fluorescein angiography (FA), electroretinography (ERG) were performed. RESULTS: At the first visit, corrected visual acuity was counting fingers at 30cm of right eye, 0.8 of left eye. Right eye presented relative afferent pupillary defect. Dilated fundus examination revealed a pale posterior pole and cherry-red spot at right eye. FA demonstrated choroidal filling delay and prolonged arteriovenous transit time. ERG demonstrated decreased amplitude of a and b wave. Twenty months after the initial visit, retinal arterial attenuation and a pale optic disc were revealed.

Transient Unilateral Visual Loss and Ophthalmoplegia Following Spine Surgery in Prone Position

PURPOSE: To report a case of transient ophthalmoplegia and visual loss caused by ophthalmic artery occlusion induced after surgery in prone position. METHODS: A 32-year-old woman was referred to the department of ophthalmology for unilateral visual loss and ophthalmoplegia after cervical spine surgery performed in prone position. Full ocular examinations, including fluorescein angiography (FAG) and electroretinography (ERG) were performed. RESULTS: On the initial visit, her right visual acuity was light perception and the left visual acuity was 1.0. Ophthalmoplegia and an afferent pupillary defect was present in the right eye. A fundus examination revealed no abnormal findings. On the 4th day, the retina in posterior pole was opacified and late phase of FAG showed fluorescein leakage from the retinal and choroidal vessels. On the 8th day, the best corrected visual acuity of the right eye was improved to 0.7 and ERG showed decreased amplitudes of both a and b waves. On the 12 th day, ocular motility was fully recovered. On the 61 st day, visual acuity of the right eye was 0.7 and ERG showed that the amplitude had improved from the initial examination.

Visual Loss after Cervical Spine Surgery in the Prone Position: A case report / 대한마취과학회지

We experienced a patient with unilateral visual loss after cervical spine surgery in the prone position. During the initial postoperative period, we were not been able to identify the patient's visual loss because of severe conjunctival edema in both eyes. Three days after surgery, the patient complained of right visual loss and was examined by an ophthalmologist. Ophthalmic artery occlusion was taken to be the presumptive cause, based on fluorescein angiography (FAG) and other evidence. He had several risk factors of ophthalmic artery occlusion, such as; prone position, compression of the eye-balls, anatomic abnormality, cervical spine and a long duration operation, intraoperative bleeding, hypotension and smoking, and a diabetic history. We concluded that attention must always be paid to a patients' eyes throughout the perioperative and postoperative period to prevent such a catastrophic postoperative complication.

A Case of Left Ophthalmic Artery Occlusion and Right Carotid Cavernous Fistula after Illegal Rhinoplasty

PURPOSE: In spite of appropriate management, ophthalmic artery occlusion has a poor prognosis and eventually progresses to the blindness or phthisis bulbi. We report one unusual cause of ophthalmic artery occlusion for the preventive purpose. METHODS: A 44 year-old woman visited emergency room with an acute visual loss in the left eye and right hemiplegia. She had undergone illegal augmentation rhinoplasty using liquid silicone one day prior to the presentation. RESULTS: Angiogram showed that injected liquid silicone entered the systemic circulation via nasal vein and induced the left cerebral infarction and left ophthalmic artery occlusion. On the 30th hospital day, right carotid cavernous fistula was developed with right ocular pain.