Epiduroscopy is a minimally invasive procedure
used to diagnose epidural fibrosis and to
release this fibrosis; epiduroscopy is also used
to precisely deposit medication into the epidural
space. It is commonly used in patients who are
diagnosed with failed back surgery syndrome
(FBSS) after more conservative treatment has
failed to provide sufficient relief of symptoms.
A rare complication of epiduroscopy is retinal
hemorrhaging, which is likely caused by overpressurization
of the epidural space during the
procedure. Patient-related risk factors for developing
retinal hemorrhage after epiduroscopy
remain largely unknown. This is the first case
report of retinal hemorrhage in a patient using
chronic dexamethasone.
We describe a 73-year-old man diagnosed with
FBSS who underwent epiduroscopy to diagnose
and relieve epidural fibrosis. The procedure was
uneventful and he was discharged from our clinic
the same day, but upon routine check-up he mentioned
blurry vision. Immediately he was referred
to an ophthalmologist who diagnosed retinal
hemorrhages in both eyes upon fundoscopic examination.
Our patient was using dexamethasone
for the treatment of allergies. Three months after
the procedure, his vision was restored fully in the
right eye and 95% in the left eye.
Chronic corticosteroid use may weaken retinal
veins, making them prone to rupture when there
is increased pressure, even for a short period
of time. Chronic use of corticosteroids must be
considered a risk factor for developing retinal hemorrhages
in patients undergoing epiduroscopy.
Long-term use of corticosteroid can be considered
as a relative contraindication for epiduroscopy.
Key words: Epiduroscopy, complications, interventional
pain, corticosteroids, retinal hemmorhage,
failed back surgery syndrome
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