title: 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.
authors.affiliation: Department of Ophthalmology, University Medical Center Regensburg, Regensburg, Germany. hufendiek@eye-regensburg.de
authors.forename: Karsten
authors.initials: K
authors.lastname: Hufendiek
authors.forename: Katerina
authors.initials: K
authors.lastname: Hufendiek
authors.forename: Thomas
authors.initials: T
authors.lastname: Finkenzeller
authors.forename: Horst
authors.initials: H
authors.lastname: Helbig
authors.forename: Carsten
authors.initials: C
authors.lastname: Framme
mesh_terms: D000208:Acute Disease; D000328:Adult; D001766:Blindness / Q000209:etiology*; D002292:Carcinoma, Renal Cell / Q000000981:diagnostic imaging / Q000556:secondary / Q000628:therapy*; D004621:Embolization, Therapeutic / Q000009:adverse effects*; D005005:Ethmoid Sinus / Q000098:blood supply* / Q000000981:diagnostic imaging; D005451:Fluorescein Angiography; D019788:Fluorodeoxyglucose F18; D006801:Humans; D007680:Kidney Neoplasms / Q000473:pathology*; D008297:Male; D009392:Nephrectomy; D009880:Ophthalmic Artery; D010255:Paranasal Sinus Neoplasms / Q000000981:diagnostic imaging / Q000556:secondary / Q000628:therapy*; D049268:Positron-Emission Tomography; D014792:Visual Acuity / Q000502:physiology
chemical_list: D019788:Fluorodeoxyglucose F18