Central Retinal Artery Occlusion after Filler Injection for Upper Lid Retraction

Purpose: We report a case of central retinal artery occlusion after filler injection for upper lid retraction. Diagnosis and treatment were performed to recover visual acuity and good results.Case summary: A 40-year-old woman presented to our clinic with upper lid retraction. She was diagnosed with hyperthyroidism and thyroid orbitopathy. She had been examined regularly at a local clinic since 2016. At the first visit, her visual acuity was 1.0/1.0 and the intraocular pressure was 19 mmHg, with no unusual findings in the anterior segment. Hyaluronic acid filler was injected into the medial part of the left upper lid. As soon as the needle was removed, she complained of blurry vision and visual impairment. This was followed by the development of a relative afferent pupillary defect; her visual acuity was hand motion at 30 cm. After 5 minutes, we performed wide fundus imaging and optical coherence tomography, which revealed retinal artery occlusion and a cherry-red spot, along with inner retina hyperreflectivity. Under a diagnosis of central retinal artery occlusion, we performed anterior chamber paracentesis, intravenous mannitol and acetazole injection, and an ocular massage. Approximately 1.5 hours after filler injection, retinal artery reperfusion and loss of the cherry red spot were observed and, after about 3 hours, her vision had recovered to 1.0 from hand motion at 30 cm.Conclusions: Central retinal artery occlusion after filler injection, when diagnosed promptly, can be treated by anterior chamber paracentesis, intravenous mannitol and acetazole injection, and ocular massage.

Central Retinal Artery Occlusion Associated with Sildenafil Overdose

Background. To report a patient with central retinal artery occlusion (CRAO) associated with sildenafil overdose. Case Presentation. A forty-two-year-old male presented three hours after sudden painless visual loss in the right eye. BCVA was counting finger in two meters, and relative afferent pupillary defect was positive. Fundus examination revealed retinal whiteness except in a limited area of papillomacular bundle and cherry red spot. He consumed two 100 mg film-coated sildenafil tablet (Vizarsin, Krka, d.d., Novo mesto, Slovenia) twelve hours apart, and the last one was six hours before visual loss. He was diagnosed with CRAO with cilioretinal artery sparing. Although we did not find any emboli, anterior chamber paracentesis was done. Four weeks later, BCVA improved to 20/80, with resolving of retinal edema. Cardiovascular, carotid arteries, and neurologic evaluations were negative for any predisposing factor. Conclusion. CRAO is a vision threatening condition that might be associated with the overdose of sildenafil.

Cosmetic Filler Blindness: Recovery After Repeated Hyaluronidase Injections

Background The rise of cosmetic injectables has seen new clinical scenarios related to complications. The scenario of hyaluronic acid (HA) aesthetic interventional induced visual loss (AIIVL) has become more recognized. While this complication is rare, there can be delayed recognition and treatment, with limited opportunity to evaluate potential treatments and establish best practice guidelines. Objectives We report a case of documented visual recovery with extra-orbital and intra-orbital hyaluronidase. Central retinal artery occlusion (CRAO) is an ischemic event requiring urgent intervention. We hope to assist protocols being developed for HA AIIVL. Methods Following loss of vision, 675 international units (IU) of hyaluronidase was given immediately to the injection site and extra-orbital area. Within four hours, 3,000 IU intra-orbital and 1,500 IU extra-orbital hyaluronidase was given in the Emergency Department (ED). Results Visual loss in a 38-year-old female, following ipsilateral glabella and nasal injection of 0.15 ml of hyaluronic acid filler Juvéderm Voluma via the nasal tip, was documented at no perception of light (NPL) with afferent pupil defect (APD), CRAO, fundoscopy showing a cherry red spot. This was associated with cerebral irritation and Magnetic Resonance Imaging (MRI) ischemia. Hyaluronidase was injected as described above. The following day, visual acuity (VA) in the affected eye recovered to 6/18 with a relative superior visual field scotoma. VA improved to 6/6 at one month. Conclusions We believe immediate injection, followed by high dose intra-orbital and extra-orbital injection of hyaluronidase, had a positive effect in this case. Recovery of vision was remarkable, from NPL to 6/6, documented at a tertiary referral eye hospital.

Tay-Sachs Disease: A Rare Storage Disorder in Children

Tay-Sachs disease is an autosomal recessive lysosomal storage disorder cause by deficiency of enzyme Beta Hexosaminidase A and leading to accumulation of GM2 gangliosides mainly in CNS, results in progressive loss of neurological functions. We report a case of 14 month old male child presented to us with neuro-developmental regression, convulsions and bilateral cherry red spot on funduscopy. The diagnosis of Tay-Sachs disease was made by marked decrease level of enzyme Hexosaminidase A. Key words: Lysosomal storage disorder, GM2 gangliosides, neuro- regression, cherry red spot, Enzyme replacement therapy.

Central retinal artery occlusion in a patient who contracted COVID-19 and review of similar cases

A 54-year-old male patient applied to our clinic with a sudden and painless loss of vision in his right eye. He was suffering from COVID-19. His best-corrected visual acuity of the right eye was finger counting from 30 cm. The fundus examination revealed the presence of a ‘cherry-red spot’ appearance in the right eye. In optical coherence tomography imaging, hyper-reflectivity was observed in the inner retinal layers as well as increased retinal thickness in the right eye. In fundus fluorescein angiography, delayed arterial filling and prolonged arteriovenous transit time were observed in the right eye. The patient was diagnosed with central retinal artery occlusion after the COVID-19 infection. In this study, we report this case and its management.

Anesthetic management for mastectomy and total hysterectomy in a 49-year-old woman with type 1 sialidosis: a case report

Background Sialidosis is an autosomal recessive glycoprotein storage disorder, caused by neuraminidase deficiency which leads to abnormal intracellular accumulation and urinary excretion of sialylated oligosaccharides, resulting in various morphological and functional disorders. Only a few reports have described the anesthetic managements of patients with sialidosis. Case presentation A 49-year-old woman with type 1 sialidosis suffered from all limb contractures, an ocular cherry-red spot, and myoclonic seizures of the limbs. She had been cognitively normal. She was separately scheduled for mastectomy under total intravenous anesthesia and total hysterectomy under combined general and epidural anesthesia uneventfully. Conclusions Our patient with type 1 sialidosis received both general and epidural anesthesia uneventfully. Anesthesiologists should carefully assess patients with sialidosis and give careful consideration to individually tailored anesthetic managements.

GM1-gangliosidosis in a Nigerian infant: A case report

Gangliosidoses belong to the group of genetic lipid metabolism disorders, caused by defects of lysosome enzymes, inherited as an autosomal recessive trait. Gangliosidosis GM1 is caused by the deficiency of the acid beta-galactosidase (GLB11) resulting in the storage of the substrate- GM1 ganglioside in brain and visceral organs. GM1 gangliosidosis comprises three phenotypes, depending on the age of onset: an infantile, juvenile and adult type. In the infantile type dysmorphic features, severe psychomotor retardation, hepatosplenomegaly, bone changes and a cherry red spot in the macular region are seen. The juvenile GM1 gangliosidosis has no such external distinguishing features. In the adult type behavioural problems, dementia, extrapyramidal problems are specifically prominent. The authors present symptoms, clinical course and laboratory findings of a one-year-old boy with a diagnosed GM1 gangliosidosis. He presented with skin rashes since birth, delay in achievement of developmental milestones, progressive weight loss and recurrent diarrhoea of six-months duration.