Acute visual loss after preoperative embolization of an ethmoidal metastasis

Abstract

An unintentional embolization of retinal arteries is rare and has been documented as a complication after embolization of arteries supplying head and neck tumors. However, occlusion of the central retinal artery with severe loss of vision has never been reported to be a complication from embolization of tumor-supplying ethmoidal branches of the ophthalmic artery. A 40 year-old male patient with a history of right nephrectomy for renal cell carcinoma underwent preoperative radiological embolization of an ethmoidal metastasis after having experienced a life-threatening sinus bleeding. Repeated probing of the ophthalmic artery with an endovascular microcatheter for particle embolization of the tumor-supplying arteries was performed under anticoagulation with heparin. Postoperatively, a standard ophthalmological examination including extended vascular evaluation by angiography was performed. After extended probing of the ophthalmic artery a marked reduction in its blood flow occurred. Despite post-interventional imaging showing persisting perfusion of the central retinal and ciliary arteries, the patient developed complete loss of vision on this side four days later. At this time fundoscopy and fluorescein angiography revealed a recanalized central artery occlusion, while indocyanin angiography showed infarctions of the choroid. Radiological intervention via the ophthalmic artery can result in complete loss of vision, even after limited and transient obstruction of the vessel.

Fibroma ossificante dei seni paranasali: diagnosi e management

“…Anastomotic connections between the ophthalmic artery and the external carotid artery are vestiges of embryonic configurations that may occasionally persist into adulthood as anatomic variants. In particular, the middle meningeal artery, which was embolised in the patient treated in our institute and affected by ABC secondary to OF, may present a small anastomosis, the recurrent meningeal artery, with the lacrimal branch of the ophthalmic artery 24 that may explain the sudden post-operative ipsilateral visual loss that occurred in our patient.…”