Varajini Joganathan & Sabrina Shah-Desai
Visual loss from aesthetic hyaluronic acid filler injections is an under-reported complication. Our study surveyed British Oculoplastic consultants and Consultant members of the British Eye Emergency Care Society, on their awareness of visual vascular complications of dermal fillers and its emergency management.
A prospective survey of the members of the British Oculoplastic Society and the British Eye Emergency Society, using the Survey Monkey platform.
There were 53 responses. Eighty five percent of responders were aware of ophthalmic artery occlusion and visual loss as a recognised complication of hyaluronic acid based fillers. Six respondents had encountered at least one case of visual loss associated with HA fillers. Approximately 27% of the respondents had some experience of the recommended appropriate management of this complication. Majority of these practitioners did not have local management guidelines for this complication (88%) nor were they aware of guidance to manage the complication (75%).
This survey captures the current experience of British Ophthalmologists and Oculoplastic Surgeons in the management of visual vascular complication with dermal fillers. This may relate to the rarity of this complication. Although there is an awareness of visual loss as a complication from aesthetic dermal fillers, there appears to be a lack of knowledge of current management guidelines across Eye Specialists in UK. It is important for practitioners to be able to recognise and manage vascular compromise and further study recommendations are made.
Bayan Al Othman, Jared Raabe, Amina Malik, Helen Li, Ashwini Kini & Andrew G. Lee
Optic nerve sheath fenestration (ONSF) is a well-known, relatively safe, and effective surgical treatment for visual loss related to papilledema. Visual loss following ONSF is uncommon but can occur from direct surgical trauma, ischemic optic neuropathy, orbital or intrasheath hemorrhage, or arterial occlusion. Transient severe (e.g., light perception (LP) or no light perception (NLP) visual loss) after ONSF is uncommon but has been reported. We describe a case of LP vision following uncomplicated ONSF with orbital imaging demonstrating significant postoperative inflammation and slow recovery after intravenous steroid treatment. We discuss the various mechanisms for this phenomenon after ONSF. To our knowledge, this is the first clinico-radiologic description with follow up and recovery of this postoperative complication of ONSF to be reported in the English language ophthalmic literature.
Prerana Kansakar & Gangadhara Sundar
Purpose: Vision loss after orbital surgery is one of the most dreaded complications faced by the orbitofacial surgeon. This literature review was conducted in an attempt to determine the risk factors for severe vision loss and discuss the applied anatomy related to various types of orbital surgery – orbital tumor excisions, orbital decompression, and post-traumatic orbital reconstruction.
Methods: A literature search was conducted via PubMed and Google Scholar. All cases of vision loss following orbital tumor biopsy or excision, orbital decompression, and orbital trauma reconstruction were reviewed.
Results: The incidence of postoperative blindness appears to be more after orbital tumor excisions (4.7%), compared to post-traumatic orbital reconstruction (2.08%) and orbital decompressions for thyroid orbitopathy (0.15%).
The causes of vision loss include ischemic optic neuropathy, traumatic optic neuropathy, retinal and ophthalmic artery occlusions, and orbital compartment syndrome.
Conclusion: Apart from careful patient selection, proper counseling about the risk of postoperative blindness is of utmost importance. Detailed preoperative treatment planning, meticulous atraumatic intraoperative dissection under direct visualization, with attention to the danger zones and vital structures, close intraoperative and postoperative monitoring, and urgent management of potentially reversible compressive causes of vision loss can improve outcomes.