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Tian Xia, Marco A Zarbin, Neelakshi Bhagat; Retinal Artery Occlusions in Young Adults; a neuro-surgical complication.. Invest. Ophthalmol. Vis. Sci. 2018;59(9):4278. doi: https://doi.org/.
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To describe the characteristics, management and outcomes of retinal artery occlusions in young after neuro-surgical procedures.
Retrospective chart review of retinal artery and ophthalmic artery occlusions between ages 18 to 50 presenting to IOVS, Rutgers New Jersey Medical School, Newark, NJ between 2011 and 2017 was conducted. Data was collected on demographics, clinical presentation, laboratory and imaging evaluation and management. Main outcome measures were visual acuity (VA) at presentation, one month, three months, six months and final.
3 eyes of 2 patients between 18-50 years-old (mean age, 34±7 years; one was male,) were found to have retinal artery occlusion immediately after neuro-surgical procedures. One patient underwent excision of pituitary non-functional adenoma and was noted to have a VA of on the first operative day due to central retinal artery occlusion. The other patient underwent an anterior skull-based approach to the anterior cranial fossa and orbital decompression for evacuation of frontal epidural empyema and excision of fibrous dysplasia involving right orbital roof, ethmoid sinus and frontal sinus; the VA in both eyes were noted on awakening to be poor at and due to bilateral CRAO. Work up included ESR, CRP, IVFA, and CT or MRI angiogram of head and neck. All three eyes had cherry red spots. Delayed CRA perfusion was present in all 3 arteries and none of these eyes had cilioretinal arteries or any obvious emboli in the retinal arteries. All three eyes post neurosurgical surgery were treated with anterior chamber paracentesis and ocular massage (IOP ~6mmHg) with no changes in VA. The post pituitary adenoma excision patient was treated with intra-ophthalmic artery tissue plasminogen activator (TPA) due to a suspicion of CRA embolus, with no changes in VA. Bilateral CRAO was likely secondary to hypoperfusion. Blood pressure was maintained with mean arterial pressure above 60 mmHg post-operatively. VA at month 1, month 3, month 6 and final did not have any changes compared to initial VA without any statistical significance: 1.6±1.3. (Snellen 20/60 to NLP).
CRAOs can occur after neurosurgical procedures due to an embolus or hypoperfusion. The visual prognosis is extremely poor is such cases.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
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