Ocular infarction following ethanol sclerotherapy of an arteriovenous malformation

Abstract

Purpose To illustrate a case of ocular infarction following percutaneous ethanol sclerotherapy of an orbital arteriovenous malformation. Observations The patient is a 31-year-old female who developed ocular infarction of the left eye with light perception vision, proptosis, ophthalmoplegia, and a cherry red spot following sclerotherapy of an orbital arteriovenous malformation. Fluorescein angiography demonstrated decreased arteriolar filling with vascular leakage, indocyanine green angiography showed decreased choroidal perfusion, and optical coherence tomography revealed full thickness retinal edema. Magnetic resonance angiography and venography were negative for venous sinus thrombosis or intracranial vascular compromise. Conclusions and Importance Ocular infarction is a rare and devastating disorder that may result in permanent vision loss. Ethanol sclerotherapy has been reported to be effective in treating arteriovenous malformations. To the best of our knowledge, this is the first report in the literature of ocular infarction following percutaneous ethanol sclerotherapy to highlight this disease with multimodal imaging.

Trans-ophthalmic Arterial Ethanol Embolotherapy for Arteriovenous Malformations: A Single Centre Experience

“…In the cohort, eleven patients (42.3%) presented with visual acuity impairments with 3 complete relief, 6 improvements. Despite that ischemic time is reported to be an indicator of poor prognosis of vision improvement 14 , our study clearly showed eradicating arteriovenous malformation using ethanol embolotherapy facilitated improvement of visual outcomes in the cases with vision impairment. The potential cause for the improved visual function may be the increased perfusion of retina after obliterating the stulas and reducing arterial steal.…”

“…Previous studies reported that treatment of AVMs fed by OphA is clinically challenging due to complex hypervascularity of AVMs and the risk of vision loss from OphA involvement 1,4,21 . Endovascular treatment is effective for AVMs 5,8,24 , and ethanol embolotherapy of periorbital and orbital AVMs improves symptoms to some extent 14,15,25 , and yet the overall results are not satisfactory. However, due to its close proximity to retinal central artery, which regulates visual acuity and extraocular movements, therapeutic approaches that are speci c for treatment of AVMs fed by OphA are scarce.…”

“…Accessibility to AVM nidus comprises transarterial, transvenous or direct puncture approaches, but there is no consensus about which is best. Percutaneous ethanol sclerotherapy extravasates into surrounding tissues resulting in catastrophic complications, including ocular infarctions or reversible blurred vision 14 . Su et al 25 reported that one AVM patient in the periorbital region received percutaneous ethanol sclerotherapy and developed a blurred vision.…”

Interventional therapy of extracranial arteriovenous malformations of the head and neck—A systematic review

“…The side effects and complications arising from the use of sclerosants and embolization agents has been well-reported [51][52][53][54][55][56]. Forty-three of the 56 articles included a description of the complications arising during or after the procedures.…”