Retinal and Choroidal Microvascular Embolization With Methylprednisolone

Gupta, Vishali; Sharma, Suryaprakash; Gupta, Aakriti; Mr, Dogra

doi:10.1097/00006982-200206000-00028

Cited by 12 publications

(5 citation statements)

References 5 publications

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“…Of note, the phenomenon of corticosteroid emboli is not unique to transforaminal injection. There are multiple reports in the literature of central retinal artery occlusion after retrobulbar or periocular corticosteroid injection (101)(102)(103)(104). In many cases, embolic material is actually visualized in small retinal arterioles (101,104).…”

Section: Adverse Central Nervous System Sequelaementioning

confidence: 99%

Injectable Corticosteroid and Local Anesthetic Preparations: A Review for Radiologists

MacMahon

Eustace²,

Kavanagh³

2009

Radiology

214

202

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Corticosteroids and local anesthetics are some of the most commonly administered medications in radiology departments. These medications have marked variability in their formulations, which may increase their adverse event profile for specific procedures. In particular, certain corticosteroid preparations are associated with adverse central nervous system (CNS) sequelae. This is most likely due to distal embolization by particulate formulations. Nonparticulate steroid formulations are not associated with such events. Local anesthetics have severe CNS and cardiac adverse effects if injected intravascularly and have recently been associated with intraarticular chondrolysis if used in large doses. This review discusses these medications with particular emphasis on their established and postulated adverse effects. The administering radiologist should be aware of these potential effects and how best to reduce their occurrence.

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Section: Adverse Central Nervous System Sequelaementioning

confidence: 99%

Injectable Corticosteroid and Local Anesthetic Preparations: A Review for Radiologists

MacMahon

Eustace²,

Kavanagh³

2009

Radiology

214

202

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show abstract

“…A single case of visual impairment subsequent to the use of nasal decongestant was also excluded. 44 All articles that described cases in which facial injection had no pure cosmetic aim, such as sclerotherapy of vascular lesions [45][46][47][48][49][50][51] and corticosteroid injections for the treatment of chalazia, 52,53 were excluded.…”

mentioning

confidence: 99%

Blindness following Cosmetic Injections of the Face

Lazzeri

Agostini

Figus

et al. 2012

Plastic and Reconstructive Surgery

324

229

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“…9,15 CRAO is a rare complication that has been demonstrated in particulate corticosteroid suspension injections performed on several facial regions, including the forehead, eyelid, orbit, nose, maxilla, mandible, and ears. 12,[19][20][21][22][23][24][25][26][27] In documented cases of CRAO following injection, the vessels occluded are primarily the choriocapillaris, posterior ciliary artery branches, and central retinal artery, which have mean vessel lumen diameters of 20 to 40, 500 to 700, and 123 to 144 μm, respectively. [28][29][30] Corticosteroid preparations have varying particle sizes, with a maximum particle size of >500 μm, exceeding the lumen diameter of the commonly occluded vessels and their smaller branches.…”

Section: Discussionmentioning

confidence: 99%

Intravenous Catheter Employed in Peritrochlear Injection of Triamcinolone in the Treatment of Trochleitis

Rubenstein

Chang

Idowu

et al. 2020

Ophthalmic Plastic &Amp; Reconstructive Surgery

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Purpose: Injection of corticosteroid into the peritrochlear region is a widely practiced and highly successful treatment option for trochleitis, conventionally using a 25- or 27-gauge needle for the steroid injection. Injection into the vascular-rich peritrochlear region poses a risk, albeit rare, of central retinal artery occlusion or orbital hemorrhage. We describe a potentially safer method of delivering triamcinolone to the peritrochlear region using a 24-gauge intravenous catheter. Methods: Interventional retrospective case series including all patients who received peritrochlear injections of triamcinolone via intravenous catheter for trochleitis by a single surgeon (BJW). Surgical technique: After a subcutaneous wheel of local anesthetic was delivered to the medial upper eyelid skin nearest to the trochlea, a 24-gauge intravenous catheter was used to penetrate the skin and orbital septum. Once past the septum, the needle was removed and the blunt catheter was advanced into the peritrochlear region. A 1-ml syringe filled with 40 mg/ml triamcinolone was attached to the catheter. After pulling back to ensure that the catheter was not intravascular, triamcinolone was delivered to the orbit. The catheter was then removed. Results: Ten catheter injections were performed on 3 patients over an 8-year period. There were no complications. Conclusion: Injection of corticosteroid into the peritrochlear region using the commonly available 24-gauge intravenous catheter is an effective and theoretically safer alternative to typical injection using a 25-gauge needle for treatment of trochleitis. Use of nonparticulate steroid solutions may further decrease the risk of adverse events.

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Retinal and Choroidal Microvascular Embolization With Methylprednisolone

Cited by 12 publications

References 5 publications

Injectable Corticosteroid and Local Anesthetic Preparations: A Review for Radiologists

Injectable Corticosteroid and Local Anesthetic Preparations: A Review for Radiologists

Blindness following Cosmetic Injections of the Face

Intravenous Catheter Employed in Peritrochlear Injection of Triamcinolone in the Treatment of Trochleitis

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