title: Sudden occurrence of Roth spots and retinal hemorrhages following endoscopic adhesiolysis: an SD-OCT evaluation.
abstract: OBJECTIVE
  To document the occurrence of Roth spots and retinal hemorrhages by spectral-domain optical coherence tomography (SD-OCT) following endoscopic adhesiolysis for failed back surgery syndrome.
  
  
  METHODS
  Case report.
  
  
  RESULTS
  A 47-year-old patient noted progressive and bilateral visual loss immediately after epidural endoscopy and endoscopic adhesiolysis. Funduscopic examination showed multiple Roth spots and retinal hemorrhages at the posterior pole and the retinal midperiphery in both eyes. Spectral-domain optical coherence tomography demonstrated that Roth spots involved the inner retina, while dot hemorrhages involved the outer retina. Most retinal hemorrhages and Roth spots resolved over 6 weeks, with complete functional recovery in both eyes. However, SD-OCT revealed multiple areas of disruption of the outer retinal layers in the left eye.
  
  
  CONCLUSIONS
  Roth spots and retinal hemorrhages can occur after endoscopic spinal surgery. Although hemorrhages resolve quickly over few weeks, SD-OCT can demonstrate that retinal damage might persist, especially in the outer retina. This finding may explain cases of incomplete recovery of visual function after complicated endoscopic adhesiolysis.
authors.affiliation: Ophthalmological Unit, Ca' Granda Foundation-Ospedale Maggiore Policlinico, Department of Clinical Sciences and Community Health, University of Milan, Milan - Italy.
authors.forename: Laura
authors.initials: L
authors.lastname: Dell'Arti
authors.affiliation: Ophthalmological Unit, Ca' Granda Foundation-Ospedale Maggiore Policlinico, Department of Clinical Sciences and Community Health, University of Milan, Milan - Italy.|Genentech Inc., South San Francisco, CA - USA.
authors.forename: Giulio
authors.initials: G
authors.lastname: Barteselli
authors.affiliation: Ophthalmological Unit, Ca' Granda Foundation-Ospedale Maggiore Policlinico, Department of Clinical Sciences and Community Health, University of Milan, Milan - Italy.
authors.forename: Valentina
authors.initials: V
authors.lastname: Pinna
authors.affiliation: Ophthalmological Unit, Ca' Granda Foundation-Ospedale Maggiore Policlinico, Department of Clinical Sciences and Community Health, University of Milan, Milan - Italy.|Eye Clinic, Department of Biomedical and Clinical Sciences "Luigi Sacco", Luigi Sacco Hospital, University of Milan, Milan - Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Invernizzi
authors.affiliation: Ophthalmological Unit, Ca' Granda Foundation-Ospedale Maggiore Policlinico, Department of Clinical Sciences and Community Health, University of Milan, Milan - Italy.
authors.forename: Chiara
authors.initials: C
authors.lastname: Mapelli
authors.affiliation: Ophthalmological Unit, Ca' Granda Foundation-Ospedale Maggiore Policlinico, Department of Clinical Sciences and Community Health, University of Milan, Milan - Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Viola
mesh_terms: D004724:Endoscopy / Q000009:adverse effects*; D004824:Epidural Space; D006801:Humans; D008297:Male; D008875:Middle Aged; D009887:Ophthalmoscopy; D012166:Retinal Hemorrhage / Q000175:diagnosis / Q000209:etiology*; D013130:Spinal Stenosis / Q000601:surgery*; D000267:Tissue Adhesions / Q000601:surgery; D041623:Tomography, Optical Coherence / Q000379:methods