Retinal vascular occlusions after nonocular surgeries / Oclusões vasculares retinianas após cirurgias não oculares

ABSTRACT Ophthalmologic complications of nonocular surgeries are rare events, but can lead to irreversible conditions of low visual acuity. They are often associated with spine, heart and neck surgery, however they can occur after procedures on other systems. The main local causes are ischemic optic neuropathies, vascular occlusions, cortical lesions, and acute angle-closure glaucoma. We report two cases of sudden low visual acuity secondary to vascular occlusions after gastrointestinal procedures. In the first case, a 57-year-old patient electively admitted for colon reconstruction after Hartmann's colostomy, progressed with intra- and postoperative complications and required subsequent complementary surgeries. Once month later he presented with sudden bilateral low visual acuity, painless and non-altitudinal, and was diagnosed as papillophlebitis, which resolved spontaneously with the progression of the condition. The second case, a 69-year-old patient with no comorbidities underwent rectal resection due to suspected malignant tumor, and progressed on the third postoperative day, with pain and bilateral low visual acuity secondary to acute angle-closure glaucoma, and branch retinal artery occlusion in right eye; treated with iridotomy and ocular hypotensive eye drops, with only slight recovery of vision. The article aims to discuss the etiological mechanisms of the reported conditions and present a literature review.

RESUMO Complicações oftalmológicas de cirurgias não oculares são raras, mas podem levar a condições irreversíveis de baixa acuidade visual. Em geral são associadas à cirurgia de coluna, coração ou pescoço, mas podem ocorrer após procedimentos em outros sistemas. As principais causas são neuropatias ópticas isquêmicas, oclusões vasculares, lesões corticais, e glaucoma agudo de ângulo fechado. Relatamos dois casos de baixa acuidade visual súbita, secundária a oclusões vasculares, após procedimentos cirúrgicos gastrointestinais. No primeiro caso, um paciente de 57 anos foi internado de forma eletiva para reconstrução do cólon após colostomia de Hartmann. Evoluiu com complicações nos períodos intra- e pós-operatório, e necessitou de outras cirurgias complementares. Um mês depois apresentou baixa acuidade visual bilateral súbita, indolor e não altitudinal, e foi diagnosticado como papiloflebite, com resolução espontânea na evolução. O segundo caso, uma paciente de 69 anos, sem comorbidades, foi submetida à ressecção do reto por suspeita de tumor maligno e, no terceiro dia de pós-operatório, evoluiu com dor e baixa acuidade visual bilateral, secundária a glaucoma agudo de ângulo fechado, e oclusão de ramo da artéria retiniana no olho direito; tratada com iridotomia e colírios hipotensores, com recuperação parcial da visão. O objetivo do artigo é discutir os mecanismos etiológicos das doenças relatadas, e apresentar uma revisão da literatura.

Central retinal artery occlusion and central retinal vein occlusion in contralateral eye / Oclusão da artéria central da retina com oclusão da veia central em olho contralateral

ABSTRACT The case of a 55-year-old male who presented central retinal vein occlusion with marked macular ischemia in left eye is reported. Despite the intervention with sustained-release dexamethasone polymer injection and other clinical measures, the visual acuity was severely reduced in left eye. After 8 months, he returned to the emergency with acute visual loss of 2 hours of progression in right eye due to a central retinal artery occlusion, sparing only the territory of the cilioretinal artery. Patient underwent clinical maneuvers with anterior chamber paracentesis and intravenous injection of tissue plasminogen activator. Fluorescein angiography immediately after the procedures showed recanalization, but despite arterial vasodilation, no complete recanalization was observed after 24 hours. The patient developed retinal atrophy.

RESUMO Apresenta-se o caso de um paciente do sexo masculino, de 55 anos, com oclusão de veia central retiniana com acentuada isquemia macular em olho esquerdo. Apesar da intervenção com injeção de polímero de liberação lenta de dexametasona e outras medidas clínicas tomadas, ele evoluiu com severa baixa da acuidade visual em olho esquerdo. Após 8 meses, retornou à emergência com perda visual aguda de 2 horas de evolução em olho direito devido à oclusão de artéria central retiniana, poupando apenas o território da artéria ciliorretiniana. O paciente foi submetido a manobras clínicas, com paracentese de câmara anterior e injeção endovenosa de ativador do plasminogênio tecidual. A angiografia fluoresceínica imediatamente após as manobras mostrou recanalização, porém, a despeito do vasodilatador arterial, não foi observada completa recanalização com 24 horas. O paciente evoluiu com atrofia retiniana.

Clinical Manifestations and Visual Prognosis of Cilioretinal Artery Sparing Central Retinal Artery Occlusion

Transient retinal artery occlusion after phacoemulsification under local anesthetic block / Oclusão arterial retiniana transitória após facoemulsificação sob bloqueio anestésico

ABSTRACT We here in report the case of a patient subjected to cataract surgery through phacoemulsification under local anesthetic block, without intra-operative complications. The patient presented important visual impairment in the first post-operative day. Fundoscopy showed pallor resembling cherry-red spots at the macula. Fluorescein angiography did not depict signs of vascular occlusion and the spectral-domain optical coherence tomography showed increased reflectivity in the inner layers of the retina, thus suggesting local thickening and edema. The current case led to the diagnostic hypothesis of transient retinal arterial occlusion.

RESUMO Relatamos um caso de um paciente submetido a facectomia por facoemulsificação sob bloqueio anestésico peribulbar, sem intercorrências per-operatória, que apresentou no primeiro dia de pós-operatório baixa visual significativa. À fundoscopia observou-se palidez em aspecto de mácula em cereja. A angiofluoresceinografia não demonstrou sinais de oclusão vascular e a tomografia de coerência óptica mostrou aumento da refletividade das camadas internas da retina, sugerindo espessamento e edema local. No caso descrito foi aventada hipótese diagnóstica de oclusão arterial retiniana transitória.

Visual Loss with Ophthalmoplegia after Prone Position Spinal Surgery

PURPOSE: We report a case of acute visual loss with ophthalmoplegia after prone position spinal surgery who had blood supply dependence on collateral circulation due to occlusion of the Internal carotid artery. CASE SUMMARY: A 74-year-old man was referred to the department of ophthalmology for acute visual loss and ophthalmoplegia after lumbar spine surgery performed in prone position. On the initial visit, his right visual acuity was 0.8 and the left visual acuity was negative light perception. Intraocular pressure was normal. There was a relative afferent pupillary defect and ophthalmoplegia of all directions in the left eye. Because of the ptosis of the upper eyelid in the left eye, it was impossible to tune the eye voluntarily. The cherry red spot and pale retina were observed on the fundus examination. On brain magnetic resonance imaging angiography, we found complete obstruction of the left internal carotid artery. He had intravenous injection of 1 g methylprednisolone for 3 days, and discharged with per oral medicine. After 1 month of treatment, the ophthalmoplegia was slightly improved, but visual acuity was not recovered. CONCLUSIONS: In this case, unlike previous reports, acute visual loss and ophthalmoplegia occurred after spinal surgery the patient who had collateral circulation for ocular blood supply because of complete obstruction of the left internal carotid artery. This report highlights the importance of being aware of the anatomical variant in possible complications of external ocular compression after non-ocular surgery.

Association of Retinal Artery Occlusion with Subclinical Coronary Artery Disease

BACKGROUND: To evaluate the association between retinal artery occlusion (RAO) and subclinical coronary artery disease (CAD). METHODS: We studied 41 patients with non-arteritic RAO without any history or symptoms of CAD, who had undergone coronary computed tomographic angiography (CCTA) for systemic atherosclerotic evaluation between 2007 and 2012. The age- and gender-matched control group comprised 4-fold subjects who were randomly selected from asymptomatic subjects who underwent CCTA during general health evaluation. Medical records and CCTA findings were compared between RAO patients and control groups. Multiple logistic regression analysis was carried out to assess the risk factors associated with CAD. RESULTS: Cardiovascular risk factors were not significantly different between RAO patients and control groups. RAO patients showed higher coronary artery calcium score than did control subjects (267.9 ± 674.9 vs. 120.2 ± 289.5). On CCTA, the prevalence of obstructive CAD (diameter stenosis ≥ 50%) in RAO patients was significantly higher than that in controls (29% vs. 15%; odds ratio [OR], 3.0). RAO patients demonstrated a significantly higher segment-involvement score (SIS) (2.6 ± 3.0 vs. 1.6 ± 2.4) and segment-stenosis score (SSS) (3.6 ± 4.8 vs. 2.0 ± 3.3) than did controls. After adjustment of associated factors, RAO showed significant association (OR, 3.0) with obstructive CAD and extensive CAD (SIS > 4: OR, 2.8; SSS > 8: OR, 3.4). CONCLUSION: Patients with RAO had a higher prevalence of subclinical obstructive CAD with a more extensive and heavier burden of coronary artery plaques than did age- and gender-matched controls. Physicians should understand the potential risk of CAD in RAO patients.

Symptomatic Retinal Artery Occlusion after Angioplasty and Stenting of the Carotid Artery: Incidence and Related Risk Factors

OBJECTIVE: Retinal artery occlusion (RAO) is rarely seen as a complication in patients undergoing carotid artery stenting (CAS); hence, its characteristics have not been documented in detail. This study aimed to investigate the incidence of this complication and the related risk factors, focusing on differences in ophthalmic artery (OA) supply (whether by the external or internal carotid artery [ECA or ICA]) prior to CAS procedures. MATERIALS AND METHODS: We retrospectively examined 342 patients who underwent CAS for severe and/or symptomatic carotid artery stenosis between January 2009 and December 2017. Cumulative medical records and radiologic data were assessed. RAO was confirmed by photography and fluorescent angiography of the fundus, which were performed by an ophthalmologist. In all patients, distal filter systems of various types were applied as cerebral protection devices (CPDs) during procedures. Univariate and multivariate analyses were conducted to identify the risk factors for RAO after CAS. RESULTS: Symptomatic RAO was observed in six patients (1.8%), of which five (6.8%) were ECA-dominant group members (n = 74). In a binary logistic regression analysis, OA supply by the ECA (odds ratio [OR], 9.705; 95% confidence interval [CI], 1.519–62.017; p = 0.016) and older age (OR, 1.159; 95% CI, 1.005–1.336; p = 0.041) were identified as significant risk factors in patients with RAO after CAS. ECA-supplied OA was also associated with the severity of ipsilateral ICA stenosis (p = 0.001) and ulcerative plaque (p = 0.021). CONCLUSION: In procedures performed using ICA distal filtering CPD systems, RAO as a complication of CAS (performed for severe stenosis) showed a relationship to ECA-supplied OA. For older patients, simultaneous use of ICA-ECA CPDs might help prevent such complications.

Cilioretinal artery branch avulsion secondary to surgical embolectomy: management and outcome. Case report / Avulsão do ramo da artéria ciliorretiniana secundária à embolectomia cirúrgica: manejo e desfecho. Relato de caso

ABSTRACT We report the trans-operative approach and short-term outcome for a patient who suffered a traumatic avulsion of the cilioretinal artery branch during the surgical management of a cilioretinal arterial branch occlusion with intraocular embolectomy. The patient underwent a pars plana vitrectomy with in situ embolectomy. The blocked artery was incised using 25 Ga vertical scissors, and embolus manipulation was performed using microsurgical forceps. During embolus extraction, the occluded cilioretinal artery and its branch were inadvertently avulsed and torn with subsequent intense bleeding. Laser and endodiathermy were used for acute hemostasis. The maneuvers created an unintended retinochoroidal anastomosis. Visual-field improvement was noted three months after the surgery. In the event of a complicated surgical embolectomy with the avulsion of the artery, the formation of a retinochoroidal anastomosis and reperfusion of the occluded artery may occur along with the improvement of the visual field in some cases.

RESUMO Relatamos a abordagem transoperatória e o desfecho em curto prazo de um paciente que sofreu uma avulsão traumática do ramo da artéria ciliorretiniana durante o tratamento cirúrgico de uma oclusão do ramo arterial ciliorretiniano com embolectomia intraocular. O paciente foi submetido a uma vitrectomia pars plana com embolectomia in situ. A artéria bloqueada foi incisada com uma tesoura vertical de 25 Ga e a manipulação do êmbolo foi feita com pinça microcirúrgica. Durante a extração do êmbolo, a artéria ciliorretiniana ocluída e seu ramo foram inadvertidamente avulsionados e rasgados com sangramento intenso subsequente. Laser e endodiatermia foram utilizados para hemostasia aguda. As manobras criaram uma anastomose retinocoroidiana não intencional. Melhora do campo visual foi observada três meses após a cirurgia. No caso de uma embolectomia cirúrgica complicada com a avulsão da artéria, a formação de uma anastomose retinocoroidiana e reperfusão da artéria ocluída pode ocorrer juntamente com a melhora do campo visual em alguns casos.

Optical coherence tomography (OCT) angiography of central retinal artery occlusion in the patent cilioretinal artery: a case report / Avaliação de paciente com oclusão de artéria central da retina com artéria cilioretiniana patente através de angiografia por tomografia de coerência óptica (OCT-A): um relato de caso

ABSTRACT Here we report the case of a 78-year-old male patient with a 2-day history of low visual acuity and fundus and who was diagnosed with central retinal artery occlusion. In addition, the patient had an allergy to fluorescein. A fundus examination of the left eye found a pink optic disc with blurred margins, diffuse pallor in the retina with arterial attenuation, and a normal band of the retinal area in the macular region. Optical coherence tomography revealed increased thickness of the inner retina. Optical coherence tomography angiography (OCT-A) revealed a decreased flow signal in the superficial layers, with reduced flow signal in the choriocapillaris. OCT-A is a valuable alternative during the follow-up period in patients with central retinal artery occlusion, particularly in those with an allergy to contrast agents. The use of this as a non-invasive examination can improve the prognosis of patients and future studies investigating the treatment of central retinal artery occlusion.

RESUMO Paciente de 78 anos do sexo masculino com história de dois dias de baixa acuidade visual em olho esquerdo e exame fundoscópico sugestivo de oclusão da artéria retiniana, além de história de alergia a fluoresceína sódica. Em exame de fundoscopia de olho esquerdo pode ser observado disco óptico róseo, mal delimitado, palidez difusa da retina, com banda em área macular apresentando cor rósea preservada. A tomografia de coerência óptica apresentava aumento de espessura de retina interna em áreas de palidez e espessura e camadas preservadas em área poupada. A tomografia de coerência óptica-A mostrou sinal diminuído em camadas superficiais, com sinal de fluxo diminuído em coriocapilar. A tomografia de coerência óptica-A é uma alternativa válida para seguimento de pacientes com oclusão da artéria retiniana, em casos de alergia ao contraste ou contra indicação ao exame. O exame é não invasivo e pode melhorar não somente a avaliação dos pacientes nos dias de hoje como aumenta possibilidades em futuros estudos e tratamentos da oclusão da artéria retiniana.

Susac's syndrome: isolated retinal artery occlusion after 10 years of remission / Síndrome de Susac: oclusão isolada da artéria retiniana após 10 anos de remissão

ABSTRACT Susac's syndrome, or microangiopathy of the retina, inner ear, and brain, is a rare condition characterized by the clinical triad of encephalopathy, branch retinal artery occlusion, and sensorineural hearing loss. The complete triad has been documented in 85% of reported cases. At clinical onset, the most common manifestations are central nervous system symptoms, followed by visual symptoms and hearing disturbances. Although the clinical course of Susac's syndrome is usually self-limiting, fluctuating, and monophasic, clinical polycyclic and chronic courses have also been described. Likewise, recurrences of the full triad after more than 10 years of remission have been reported. We describe a 21-year-old woman who presented with branch retinal artery occlusions and magnetic resonance imaging findings compatible with Susac's syndrome without objective hearing loss. After 10 years of remission, the patient complained of visual field loss due to new retinal ischemia. Neither other symptoms nor neuroimaging or audiometry pathologic findings were found during the clinical course.

RESUMO A síndrome de Susac, ou a micro angiopatia da retina, do ouvido interno e do cérebro, é uma condição rara caracterizada pela tríade clínica de encefalopatia, oclusão de ramo da artéria retiniana e perda de audição neuro-sensorial. A tríade completa é documentada em 85% dos casos registrados. No início dos sinais clínicos, a manifestação mais comum relaciona-se ao sistema nervoso central, seguida por sintomas visuais e distúrbios auditivos. Apesar do curso clínico da síndrome de Susac ser usualmente auto limitante, variável e monofásico, cursos clínicos policíclicos e crônicos têm sido também descritos. Do mesmo modo, recorrências da tríade completa após mais de 10 anos de remissão têm sido relatadas. Descrevemos o caso de uma mulher de 21 anos que apresentava oclusões de ramos da artéria retiniana e imagens por ressonância magnética compatíveis com a síndrome de Susac, sem comprometimento objetivo da audição. Dez anos após a remissão, a paciente queixou-se de perda de campo visual devido a uma nova isquemia da retina. Nenhum outro sintoma, ou neuroimagem ou achado audiométrico patológico foi observado durante o curso clínico.

Trombolisis intrarterial en la oclusión de la arteria central de la retina / Intra-arterial thrombolysis in central retinal artery occlusion

La oclusión de la arteria central de la retina es considerada una urgencia oftalmológica con mal pronóstico visual, a pesar de los métodos convencionales de tratamiento. Los recientes avances en neurorradiología permiten realizar un cateterismo selectivo en la arteria oftálmica e inyectar un agente fibrinolítico cerca del lugar de la obstrucción. Esta intervención podría ser efectiva en ciertos tipos de oclusiones y se han obtenido resultados prometedores en pacientes con oclusiones de la arteria central de la retina. Se realizaron búsquedas en diferentes publicaciones relacionadas con la especialidad en los últimos 10 años en bases de datos de revistas líderes de Oftalmología, con el objetivo de mostrar la trombolisis intrarterial como opción de tratamiento para la oclusión de la arteria central de la retina. La baja incidencia de esta enfermedad, además de que los pacientes acuden a consulta con frecuencia fuera del periodo de ventana, son justificantes por las que no se recogen respuestas definitivas, lo que se suma a la heterogenicidad de tratamiento coadyuvante empleado en los diferentes centros y al uso de fibrinolíticos y de dosis variados. Se requieren ensayos clínicos aleatorizados que permitan determinar su superioridad frente a las medidas convencionales, el grado de beneficio en contraposición al riesgo de eventos adversos y el tipo de pacientes que son candidatos a esta medida terapéutica que se avecina de manera prometedora para mejorar el pronóstico visual de estos pacientes(AU)

The occlusion of the retina central artery is considered an ophthalmological emergency with poor visual prognosis, despite conventional treatment methods. Recent advances in neuroradiology allow a selective catheterization in the ophthalmic artery and inject a fibrinolytic agent near the site of the obstruction. This intervention could be effective in certain types of occlusions and promising results have been obtained in patients with Central Retina Artery occlusions. We searched different publications related to the specialty, using the database of leading journals of ophthalmology, in the last 10 years; with the objective of showing intra-arterial thrombolysis as an option of treatment for the Retinal Central Artery Occlusion. The low incidence of this disease, together with the fact that patients frequently visit outside the window period, are justifying why no definitive answers are collected, which adds to the heterogeneity of coadjutant treatment used in the different centers, controversial window period and use of fibrinolytics and varied doses. Randomized clinical trials are required to determine its superiority to conventional measures, the degree of benefit as opposed to the risk of adverse events and the type of patients that are candidates for this therapeutic approach that is promising to improve the visual prognosis of these patients(AU)

Successful treatment of central retinal artery occlusion using hyperbaric oxygen therapy

Central retinal artery occlusion (CRAO) is considered an ophthalmologic emergency. The prognosis of this disease is very poor. Currently, there is no generally effective therapy available to treat CRAO. Hyperbaric oxygen therapy (HBOT) can increase the volume of oxygen delivered to the ischemic retinal tissue until spontaneous or assisted reperfusion occurs. We report the case of a patient who experienced sudden visual loss due to CRAO that was treated with HBOT. The patient was an 81-year-old woman who presented with CRAO in her right eye (OD). She exhibited “hand motion” visual acuity before treatment. She underwent three sessions of HBOT at a pressure of 2.8 atmospheres absolute, performed over 3 days. After 4 days in hospital, her visual acuity improved to 0.4 (OD) for far vision and 0.5 (OD) for near vision. Her vision was stable without the supply of oxygen; therefore, she was discharged.

Optical Coherence Tomography Measurement and Visual Outcome in Acute Central Retinal Artery Occlusion

PURPOSE: This study investigated visual acuity (VA) values and differences depending on optical coherence tomography (OCT) findings in patients with acute central retinal artery occlusion (CRAO). METHODS: A retrospective chart review was performed on patients with acute CRAO who underwent macular and disc OCT. We evaluated changes in macular thickness and retinal nerve fiber layer (RNFL) thickness after acute CRAO onset based on OCT. We also determined the association of thickness changes with VA improvement. RESULTS: This study involved both eyes in a total of 12 patients with acute CRAO. A significant increase was observed in foveal (1 mm) thickness (p = 0.002), parafoveal (3 mm) thickness (p = 0.002), and peripapillary RNFL thickness (p = 0.005) in affected eyes with CRAO, but not in central foveal thickness (p = 0.266). A significant small difference in both eyes (affected eye – fellow eye) was shown in foveal (1 mm) and mean parafoveal (3 mm) thickness in the improved VA group (p = 0.008 and p = 0.004, respectively), but not in central foveal or peripapillary RNFL thickness (both p = 0.283). CONCLUSIONS: Both macular and RNFL thickness increased in patients with acute CRAO. RNFL thickness decreased over time with progression of RNFL atrophy. Less macular damage caused by acute CRAO could be predicted by a small difference in macular thickness between eyes (affected eye – fellow eye). In such cases, patients had a greater chance of VA improvement.

A Case of Orbital Apex Syndrome with Central Retinal Artery and Vein Occlusion Following Trauma

PURPOSE: To report a case of orbital apex syndrome (OAS) combined with central retinal artery occlusion (CRAO) and central retinal vein occlusion (CRVO) following blunt trauma. CASE SUMMARY: A 4-year-old female visited the hospital following a traffic accident. She was admitted because of multiple fractures of the skull and pneumocephalus. On day 5, she was referred to us with decreased visual acuity in her right eye. Her initial visual acuity was hand motions in the right eye and 0.8 in the left eye. The right eye showed a dilated pupil, ptosis, and total ophthalmoplegia, and the left eye showed limited abduction. A fundus examination revealed multiple retinal hemorrhages, tortuous veins, and an edematous white retina with a cherry-red spot in the right eye. Brain magnetic resonance imaging revealed an entrapped right optic nerve because of bony fragments in the orbital apex. The patient was diagnosed with OAS accompanied by CRAO and CRVO in the right eye, and with traumatic abducens nerve palsy in the left eye. After 6 months, the visual acuity was hand motions, and the fundus examination showed absorbed retinal hemorrhages, pale discs, and general retinal thinning of the right eye. Ptosis of the right eye and extraocular muscle movement of both eyes were improved. CONCLUSIONS: Combined CRAO and CRVO following trauma is very rare and is even more rarely associated with OAS. It is important for clinicians to be aware of the potential for central retinal vessel occlusions and OAS in cases of blunt ocular trauma.

Successful Endovascular Thrombectomy in a Patient with Monocular Blindness Due to Thrombus of the Ophthalmic Artery Orifice

BACKGROUND: Retinal artery occlusion can lead to sudden visual loss without pain. The acute management of retinal artery occlusion remains unresolved. CASE REPORT: A 65-year-old male was hospitalized to an emergency room for visual loss on the left side within 6 hours of onset. Combined occlusion at retinal artery and ciliary artery was confirmed by an ophthalmologist and we assessed ophthalmic artery occlusion. However, MRA revealed no significant steno-occlusion of internal carotid artery. Transfemoral cerebral angiography was carried out immediately and showed a movable thrombus at the orifice of the ophthalmic artery. We decided on endovascular thrombectomy to prevent permanent visual loss. Finally, his visual acuity was improved after successful thrombectomy. CONCLUSIONS: Although MRA is intact, small thrombus right at the orifice of the ophthalmic artery can cause a sudden monocular visual loss due to occlusion of the retinal artery. In this setting, urgent endovascular thrombectomy can offer visual improvement.

Post operative visual loss after cervical laminectomy in prone position / Perda visual no pós-operatório de laminectomia cervical em pronação

Abstract Postoperative visual loss is a rare and devastating complication. The estimated incidence is 0.01-1% after non ocular surgery. It has been reported after spine, cardiac and head and neck surgeries. We report a patient who was operated for cervical laminectomy in prone position and complained of loss of vision in one eye postoperatively. He was thoroughly investigated after visual loss. The case was diagnosed as central retinal artery occlusion (CRAO) of the left eye. Here we consider the potential etiological factors causing this unilateral loss of vision and try to suggest strategies to reduce the incidence of the complication in spinal surgery.

Resumo A perda visual pós-operatória é uma complicação rara e devastadora. A incidência estimada é de 0,01-1% após cirurgia não oftalmológica. Há relatos de sua ocorrência após cirurgias da coluna, cardíaca e de cabeça e pescoço. Relatamos o caso de um paciente submetido à laminectomia cervical em pronação que se queixou de perda de visão em um dos olhos no pós-operatório. O paciente foi profundamente investigado após a perda visual. O caso foi diagnosticado como oclusão da artéria central da retina (CRAO) do olho esquerdo. Aqui consideramos os potenciais fatores etiológicos que causam essa perda unilateral da visão e tentamos sugerir estratégias para reduzir a incidência dessa complicação em cirurgia de coluna vertebral.

Incidence of anterior segment neovascularization during intravitreal treatment for macular edema secondary to central retinal vein occlusion / Incidência de neovasos de segmento anterior durante o tratamento de edema macular secundário a oclusão da veia central da retina

ABSTRACT Purpose: To analyze the effects of injections of intravitreal triamcinolone acetonide (IVTA) and intravitreal bevacizumab (IVB) on the incidence rates of anterior segment neovascularization (ASN) and neovascular glaucoma (NVG) in patients with macular edema secondary to central retinal vein occlusion (CRVO). Methods: In this prospective, randomized, double-masked, sham-controlled study, 35 patients with macular edema following CRVO were randomized to intravitreal bevacizumab, intravitreal triamcinolone acetonide, or sham injections during the first 6 months of the study. The primary outcome was the incidence rate of ASN at month 6. The secondary outcomes were the mean changes from baseline in best-corrected visual acuity (BCVA) and central foveal thickness (CFT) on optical coherence tomography over time to month 12. Results: ASN developed in 8 (22.86%) eyes, including 5 (62.50%) eyes in the sham group and 3 (37.50%) eyes in the IVTA group, during 12 months of fol low-up (p=0.009). BCVA differed significantly (p<0.05) among the groups only at month 1. CFT did not differ significantly (p<0.05) among the groups over 12 months. NVG required surgery and developed in one eye despite laser treatment. Conclusion: Early treatment with intravitreal antivascular endothelial growth factor therapy decreases the rates of ASN and NVG after CRVO.

RESUMO Objetivo: Analisar as taxas de incidência de neovascularização do segmento anterior (NSA) e de glaucoma neovascular (GNV), em pacientes com edema macular secundário a oclusão de veia central da retina (OVCR), em tratamento com injeções intravítreas de triamcinolona (IVTA) ou bevacizumab (IVB). Métodos: Neste estudo prospectivo, randomizado, duplo mascarado e sham controlado, 35 pacientes com edema macular secundário a OVCR foram randomizados para IVB, IVTA ou para o grupo controle (sham), durante os 6 primeiros meses do estudo. O desfecho primário foi a taxa de incidência de NSA no mês 6. Os desfechos secundários foram alterações médias da acuidade visual corrigida (BCVA) e espessura foveal central (EFC) ao exame de tomografia de coerência óptica, até o mês 12. Resultados: NSA ocorreu em oito (22,86%) olhos, cinco (62,50%) olhos no grupo sham e três (37,50%) olhos no grupo tratado com injeções intravítreas de Triamcinolona, Não houve nenhum caso com NSA no grupo tratado com bevacizumab durante 12 meses de acompanhamento (p=0,009). A BCVA apresentou diferença estatisticamente significante (p<0,05) entre os grupos, somente no mês 1. A EFC não apresentou diferenças estatisticamente significantes (p<0,05) entre os grupos ao longo dos 12 meses. GNV ocorreu em um olho apesar do tratamento com laser e este paciente necessitou de intervenção cirúrgica. Conclusão: O tratamento precoce com injeções intravítreas de Anti VEGF podem diminuir as taxas de neovascularização do segmento anterior e glaucoma neovascular após oclusão de veia central da retina.

The Penumbra Obscura Stimulates Iris Neovascularisation after Isolated Central Retinal Artery Occlusion

No abstract available.

Clinical Features of Pregnancy-associated Retinal and Choroidal Diseases Causing Acute Visual Disturbance

PURPOSE: To report clinical features of patients with retinal and choroidal diseases presenting with acute visual disturbance during pregnancy. METHODS: In this retrospective case series, patients who developed acute visual loss during pregnancy (including puerperium) and visited a tertiary hospital from July 2007 to June 2015, were recruited by searching electronic medical records. Patients were categorized according to the cause of visual loss. Clinical features and required diagnostic modalities were analyzed in the retinal and choroidal disease group. RESULTS: Acute visual loss occurred in 147 patients; 49 (38.9%) were classified into the retinal and choroidal group. The diagnoses included central serous chorioretinopathy (22.4%), hypertensive retinopathy with or without pre-eclampsia (22.4%), retinal tear with or without retinal detachment (18.4%), diabetic retinopathy progression (10.2%), Vogt-Koyanagi-Harada disease (4.1%), retinal artery occlusion (4.1%), multiple evanescent white dot syndrome (4.1%), and others (14.3%). Visual symptoms first appeared at gestational age 25.9 ± 10.3 weeks. The initial best-corrected visual acuity (BCVA) was 0.27 ± 0.39 logarithm of the minimum angle of resolution (logMAR); the final BCVA after delivery improved to 0.13 ± 0.35 logMAR. Serious visual deterioration (BCVA worth than 20 / 200) developed in two patients. Differential diagnoses were established with characteristic fundus and spectral-domain optical coherence tomography findings in all cases. CONCLUSIONS: In pregnant women with acute visual loss, retinal and choroidal diseases are common and could be vision threatening. Physicians should be aware of pregnancy-associated retinal and choroidal diseases and their clinical features. The differential diagnosis can be established with non-invasive techniques.

A Case Report of Central Retinal Artery Occlusion Caused by Cardiac Myxoma

PURPOSE: We report the case of a patient diagnosed with central retinal artery occlusion caused by cardiac myxoma who underwent surgery to remove the myxoma. CASE SUMMARY: A 47-year-old woman came to our clinic presenting with a sudden decrease of visual acuity in the left eye. At the first visit, left eye visual acuity was hand motion, and intraocular pressure was 15.4 mmHg. A relative afferent pupillary defect was observed in the left eye. On fundus examination, a pale retina and cherry-red spot were observed at the posterior pole. On optical coherence tomography, macular edema was found. On fluorescein angiography and indocyanine green angiography, delayed blood circulation of the retina and choroid was found at early and late stages. Cerebral angiography was performed in the neurosurgery department and showed no occlusion of the ophthalmic artery. Cardiac ultrasonography and brain magnetic resonance imaging were performed. On cardiac ultrasonography, 4.46 × 2.09 cm cardiac myxoma was found. Resection of the cardiac myxoma was conducted in the thoracic and cardiovascular surgery department. Multiple cerebral infarcts were detected by brain imaging, and antithrombotic treatment was administered. After one month, blood circulation in the retina and choroid was observed in fluorescence angiography, but there was no improvement of visual acuity. At the 3-month follow-up visit, macular edema was decreased, but retinal atrophy and epiretinal membrane were observed on optical coherence tomography. CONCLUSIONS: Central retinal artery occlusion is a disease related to one's general condition. We experienced this case of central retinal artery occlusion caused by cardiac myxoma.