title: Successful treatment of central retinal artery thromboembolism with ocular massage and intravenous acetazolamide.
abstract: A 67-year-old woman presented with left-sided headache and blurred vision, worse during hypertensive episodes. CT angiography showed a 4 mm left internal carotid artery (ICA) aneurysm incorporating the ophthalmic artery. She passed a test balloon occlusion, so the aneurysm was coil occluded, without immediate complication. Four days postprocedure she experienced sudden loss of vision in the left eye and funduscopy showed central retinal artery occlusion secondary to emboli from the coiled aneurysm. She was treated promptly with intravenous acetazolamide and ocular massage and regained full visual acuity. Thromboembolism to the eye during or after neurointerventional treatment is a relatively rare but devastating complication. This report demonstrates the effectiveness of combined intravenous acetazolamide and ocular massage in dealing with this complication when delivered promptly.
authors.affiliation: St George's Hospital, London, UK.
authors.forename: Oliver
authors.initials: O
authors.lastname: Duxbury
authors.affiliation: Department of Radiology, Royal Free Hospital, London, UK.
authors.forename: Pervinder
authors.initials: P
authors.lastname: Bhogal
authors.affiliation: London, UK.
authors.forename: Geoffrey
authors.initials: G
authors.lastname: Cloud
authors.affiliation: London, UK.
authors.forename: Jeremy
authors.initials: J
authors.lastname: Madigan
mesh_terms: D000086:Acetazolamide / Q000008:administration & dosage*; D000368:Aged; D000783:Aneurysm / Q000000981:diagnostic imaging* / Q000628:therapy*; D000792:Angiography / Q000379:methods; D021721:Balloon Occlusion / Q000009:adverse effects* / Q000379:methods; D003131:Combined Modality Therapy; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D007262:Infusions, Intravenous; D008405:Massage / Q000379:methods; D009880:Ophthalmic Artery; D015356:Retinal Artery Occlusion / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D042262:Retinoscopy / Q000379:methods; D018570:Risk Assessment; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014786:Vision Disorders / Q000175:diagnosis / Q000209:etiology; D014792:Visual Acuity
chemical_list: D000086:Acetazolamide