Li Gang, Xu Dongdong, Hu Zhirou, Li Hui
Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing.
Department of Ophthalmology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, China.
Medicine (Baltimore). 2018 Apr;97(17):e0467. doi: 10.1097/MD.0000000000010467.
Retinal and choroidal vascular occlusion is a vision-threatening complication of therapeutic injections in the facial region. The early identification and early treatment are necessary to reduce the risk of harm to the patient.
We report an extremely rare case of embolic retinal and choroidal vascular occlusion after peribulbar triamcinolone injection in a patient with thyroid-associated ophthalmopathy.
Central retinal artery occlusion.
First, we performed a fundus examination in the patient. Triamcinolone embolus was observed in both retinal and choroidal vessels. Anterior chamber paracentesis and ocular massage combined with venous injections of alprostadil and Ginaton as well as an acupoint injection of compound anisodine were performed immediately. Sublingual glyceryl trinitrate and intraocular pressure-lowering drugs were also administered. Fundus autofluorescence, optical coherence tomography-angiography, fundus fluorescein angiography (FFA), and indocyanine green angiography (ICGA) were also conducted to evaluate the patient's condition.
One month after the onset of the situation, the triamcinolone embolus had disappeared. The retinal edema and retinal blood perfusion were also improved. The patient's visual acuity had recovered from inexact light perception to 0.02.
Embolic retinal and choroidal vascular occlusion is vision-threatening disease. Measures such as careful aspiration before injecting in the facial region must be taken to avoid such complications.
视网膜和脉络膜血管阻塞是面部治疗性注射的一种威胁视力的并发症。早期识别和早期治疗对于降低对患者造成伤害的风险是必要的。
我们报告了一例甲状腺相关性眼病患者在球周注射曲安奈德后发生栓塞性视网膜和脉络膜血管阻塞的极其罕见病例。
视网膜中央动脉阻塞。
首先，我们对患者进行了眼底检查。在视网膜和脉络膜血管中均观察到曲安奈德栓子。立即进行前房穿刺和眼部按摩，同时静脉注射前列地尔和金纳多，并进行复方樟柳碱穴位注射。还给予了舌下含服硝酸甘油和降眼压药物。还进行了眼底自发荧光、光学相干断层扫描血管造影、眼底荧光血管造影（FFA）和吲哚菁绿血管造影（ICGA）以评估患者的病情。
发病一个月后，曲安奈德栓子消失。视网膜水肿和视网膜血液灌注也得到改善。患者的视力从不确定的光感恢复到了0.02。
栓塞性视网膜和脉络膜血管阻塞是一种威胁视力的疾病。在面部注射前必须采取如仔细抽吸等措施以避免此类并发症。
