Endoscopic sinus surgery (ESS) is a generally benign, minimally invasive procedure used for management of paranasal sinus diseases, although complications may occur due to proximity of vital structures such as the brain, orbit and great vessels.1 The overall ESS major complication rate is 0.5-1%, of which orbital injury accounts for 0.09% due to direct trauma.2 We report a case of unilateral delayed sudden visual loss without orbital trauma observed intraoperatively or on post[1]operative imaging studies, following a seemingly routine endoscopic sinus surgery for chronic rhinosinusitis.
Ophthalmic Artery ; Blindness

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.
Angiography ; Angioplasty ; Carotid Arteries ; Carotid Artery, Internal ; Carotid Stenosis ; Constriction, Pathologic ; Humans ; Incidence ; Logistic Models ; Medical Records ; Multivariate Analysis ; Ophthalmic Artery ; Photography ; Retinal Artery Occlusion ; Retinal Artery ; Retinaldehyde ; Retrospective Studies ; Risk Factors ; Stents ; Ulcer

OBJECTIVE: Identifying collaterals from external carotid artery (ECA) is necessary before treatment of ophthalmic artery (OphA) aneurysm. We present a manual carotid compression test to verify collaterals in ophthalmic artery aneurysms, and evaluate its usefulness.MATERIALS AND METHODS: From March 2013 to December 2017, endovascular coiling was performed 19 consecutive patients with 20 OphA aneurysms. We performed manual carotid compression test for patients who had aneurysms incorporating entry of OphA. Clinical and angiographic outcomes were investigated.RESULTS: Of 13 cases underwent manual carotid compression test, 12 cases were confirmed collateral flow from ECA to OphA. During the coil embolization, we tried to maintain the original OphA flow even if it has a collateral anastomosis. Among them, OphA occlusion occurred in one patient during coiling. Recurrence of aneurysm was occurred in a ruptured case and additional embolization was required.CONCLUSIONS: The manual carotid compression test is useful method to identify the collaterals from ECA in patients with OphA aneurysm. This test can be used as a screening test for confirming collateral flow in OphA aneurysms or as an alternative for patients who are difficult to perform BTO.
Aneurysm ; Carotid Artery, External ; Embolization, Therapeutic ; Humans ; Mass Screening ; Methods ; Ophthalmic Artery ; Recurrence

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.
Aged, 80 and over ; Atmosphere ; Emergencies ; Female ; Humans ; Hyperbaric Oxygenation ; Ophthalmic Artery ; Oxygen* ; Prognosis ; Reperfusion ; Retinal Artery Occlusion* ; Retinal Artery* ; Retinaldehyde ; Visual Acuity

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.
Aged ; Blindness ; Carotid Artery, Internal ; Cerebral Angiography ; Ciliary Arteries ; Emergency Service, Hospital ; Humans ; Male ; Ophthalmic Artery ; Retinal Artery ; Retinal Artery Occlusion ; Thrombectomy ; Thrombosis ; Visual Acuity

No abstract available.
Epinephrine* ; Injections, Subcutaneous* ; Lidocaine* ; Ophthalmic Artery*

PURPOSE: To investigate the effect of cilostazol on ocular hemodynamics and to determine whether the administration of cilostazol increases the ocular blood flow in patients with diabetic retinopathy. METHODS: This prospective observational study investigated the effect of orally administered cilostazol on diabetic retinopathy. Before and after administration for 1 week, pulsatile ocular blood flow (POBF) and retrobulbar hemodynamics were measured using a POBF analyzer and transcranial Doppler imaging, respectively. Visual acuity, intraocular pressure, and blood pressure were also evaluated before and after treatment. RESULTS: Twenty-five eyes of 25 patients were included in this study. POBF increased significantly (16.8 ± 4.6 µL/sec vs. 19.6 ± 6.2 µL/sec, p < 0.001) after administration of cilostazol, while no significant change was identified in visual acuity, intraocular pressure, and blood pressure. Mean flow velocity in the ophthalmic artery as measured with transcranial Doppler imaging also increased significantly after medication (23.5 ± 5.6 cm/sec vs. 26.0 ± 6.9 cm/sec, p = 0.001). The change in POBF directly correlated with the change in mean flow velocity (r = 0.419, p = 0.007). CONCLUSIONS: Cilostazol was effective in increasing ocular blood flow in patients with diabetic retinopathy, possibly by modulating retrobulbar circulation.
Administration, Oral* ; Blood Flow Velocity ; Blood Pressure ; Diabetic Retinopathy* ; Hemodynamics ; Humans ; Intraocular Pressure ; Observational Study ; Ophthalmic Artery ; Prospective Studies ; Pulsatile Flow ; Visual Acuity

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.
Angiography ; Atrophy ; Blood Circulation ; Brain ; Cerebral Angiography ; Choroid ; Epiretinal Membrane ; Female ; Fluorescein Angiography ; Follow-Up Studies ; Hand ; Humans ; Indocyanine Green ; Intraocular Pressure ; Macular Edema ; Magnetic Resonance Imaging ; Middle Aged ; Myxoma* ; Neuroimaging ; Neurosurgery ; Ophthalmic Artery ; Pupil Disorders ; Retina ; Retinal Artery Occlusion* ; Retinal Artery* ; Retinaldehyde ; Tomography, Optical Coherence ; Ultrasonography ; Visual Acuity

PURPOSE: To measure and compare the ocular blood-flow velocity of ophthalmic artery in patients with central serous chorioretinopathy (CSC); affected eyes, asymptomatic fellow eyes, and CSC resolved eyes using transcranial Doppler ultrasonography. METHODS: A total of 31 patients (age 20-52 years) with CSC were evaluated using power motion mode Doppler 150 digital transcranial Doppler ultrasonography. The peak systolic velocity (PSV), peak diastolic velocity (PDV), and resistance index (RI) were measured in the ophthalmic artery of both affected and asymptomatic fellow eyes. After 2 months, 23 patients with resolved serous retinal detachment underwent repeated measurement of the above hemodynamic indices. RESULTS: The PSV and PDV of the ophthalmic artery were 30.05 ± 5.34 cm/sec and 14.07 ± 2.90 cm/sec in affected eyes and 33.03 ± 2.00 cm/sec and 17.17 ± 2.76 cm/sec in asymptomatic fellow eyes, respectively. Both indices were significantly lower in affected eyes (p = 0.004, p < 0.001, respectively). The RI was 0.52 ± 0.08 in affected eyes and 0.43 ± 0.04 in fellow eyes, a significant difference (p < 0.001). After 2 months, in 23 eyes with resolved CSC, the PSV and PDV were 32.94 ± 6.24 cm/sec and 15.54 ± 2.88 cm/sec, respectively. Both indices were significantly higher than at baseline (p = 0.031, p = 0.045, respectively). However, RI was 0.48 ± 0.04 and was not significantly different (p = 0.073). CONCLUSIONS: The CSC-affected eyes showed lower ocular blood-flow velocity and higher RI than the asymptomatic fellow eyes. The ocular blood-flow velocity was increased as CSC was resolved. These findings provide insights into the ophthalmic arterial vascular factors related to the pathogenesis of CSC.
Central Serous Chorioretinopathy* ; Hemodynamics ; Humans ; Ophthalmic Artery ; Retinal Detachment ; Ultrasonography, Doppler, Transcranial*

PURPOSE: To describe a case of Wyburn-Mason Syndrome, which is a rare phakomatosis, and its associated optical coherence tomography findings. CASE SUMMARY: A 5-year-old boy was referred to our clinic for decreased vision in his right eye. He had nevus flammeus on his right forehead, upper eyelid, and cheek. His best corrected visual acuity was hand motion in the right eye, in which a relative afferent pupillary defect was noted. Fundus examination of the right eye showed marked dilation and tortuosity of retinal vessels, which could not be discriminated between arteries and veins on the posterior pole. Optical coherence tomography showed multiple large intraretinal vessels without involvement of the internal limiting membrane. Cerebral angiography revealed arteriovenous malformations (AVMs) and feeder vessels from the internal carotid artery to the ophthalmic artery, extending to the ethmoidal artery in the nasal cavity. CONCLUSIONS: Wyburn-Mason syndrome is a rare phakomatoses and shows unique retinal AVM. Misdiagnosis or undertreatment of Wyburn-Mason syndrome can lead to serious complications. Patients with facial nevus flammeus should undergo thorough ocular examinations to rule out this disorder. Optical coherence tomography is a useful method for understanding structural features of retinal vascular malformations in Wyburn-Mason syndrome.
Arteries ; Arteriovenous Malformations ; Carotid Artery, Internal ; Cerebral Angiography ; Cheek ; Child, Preschool ; Diagnostic Errors ; Eyelids ; Forehead ; Hand ; Humans ; Male ; Membranes ; Methods ; Nasal Cavity ; Neurocutaneous Syndromes ; Nevus* ; Ophthalmic Artery ; Port-Wine Stain* ; Pupil Disorders ; Retinal Vessels ; Retinaldehyde ; Tomography, Optical Coherence* ; Vascular Malformations ; Veins ; Visual Acuity