Title

CILIORETINAL ARTERY OCCLUSION AFTER NASAL ENDOSCOPIC SURGERY: A CASE REPORT

Introduction

Nasal endoscopic surgery (FESS) is established as a safe and efficient method for the treatment of nasal and paranasal sinuses diseases. This poster aims to report the first case of cilioretinal artery occlusion after FESS.

Methods

Case report and review of the relevant literature about FESS and retinal arterial occlusion.

Results

35-year-old patient, male, admitted to an eye care due to a scotoma in the left eye for four days, which began immediately after a FESS. Ophthalmological examination presented with visual acuity of 20/20 in the right eye (OD). Left eye (OS) was 20/25. However, OS presented with a paracentral scotoma. Dilated fundus, appeared normal in the right eye. In the left eye there was an intense retinal paleness on the temporal juxtapapillary region, sparing the fovea. Optical Coherence Tomography Angiography confirmed the cilioretinal artery occlusion in the left eye. The computerized campimetry was normal in the right eye and showed centrocecal defect in the left eye No therapeutic measures were taken, because the consequences presented were irreversible with this evolution time.

Discussion

Retinal artery occlusions are rare complications in FESS. This case describes a patient with exclusive occlusion of the cilioretinal artery on the left eye due to nasal endoscopic surgery, a fact never before described in the literature. Once genetic causes and thrombophilia were excluded, the suspicion might be two possible etiologies for this occlusion: 1 – Fatty embolism. Considered the least probable in this case, due to minimal surgical manipulation and the absence of risk factors presented by the patient and; 2 – vasospasms resulting from the infiltration of dilute adrenaline in the nasal septum as much as on the inferior turbinate during the surgical procedure, which is the main hypothesis for the occlusion presentaded by the patient. Regardless of the cause, delay in diagnosis limits the treatment of these patients, who in their majority, present low visual prognosis.

Keywords

cilioretinalarteryocclusion, cilioretinalartery, nasal endoscopicsurgerycomplication.

Area

CLINICAL CASE

Authors

RENATA BIGOLIN SIVIERO, MARCELLO QUADROS RIBEIRO, LUIZ GUSTAVO BETASSI NOCERA, CARLOS AUGUSTO MOREIRA-NETO, CARLOS AUGUSTO MOREIRA JR, RAPHAEL SANTANA MIRALDI CLEMENTE, THIAGO ISSAMU SWIECH, RAFAELA BIGOLIN SIVIERO