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Bilateral retinal embolization associated with intralesional corticosteroid injection for capillary hemangioma of
M S Ruttum1, G W Abrams, G J Harris
1Department of Ophthalmology, Medical College of Wisconsin, Milwaukee.
Insights
Intralesional corticosteroid injection for infantile hemangioma can cause vision loss due to retrograde flow. This rare complication led to severe visual impairment in one eye of an infant.
Area of Science:
- Ophthalmology
- Pediatric Medicine
- Vascular Anomalies
Background:
- Infantile capillary hemangiomas can cause ocular complications like amblyopia.
- Intralesional corticosteroid injections are a treatment option for problematic hemangiomas.
Observation:
- A 2-month-old infant developed visual inattention and bilateral vision loss 48 hours after corticosteroid injection for a periocular hemangioma.
- Examination revealed inability to fixate or follow, afferent pupillary defect, and significant intraretinal and preretinal hemorrhages in both eyes.
Findings:
- The patient experienced severe vision loss in the left eye with persistent afferent pupillary defect and macular scarring.
- The right eye's visual acuity normalized after hemangioma regression, but the left eye's vision remained compromised.
Implications:
- Retrograde flow of corticosteroid suspension through ophthalmic arteries is the likely cause of this vision-threatening complication.
- Careful consideration of vascular anatomy and potential complications is crucial when performing intralesional corticosteroid injections near the eye.
Abstract:
A 2-month-old female infant underwent intralesional corticosteroid injection for a capillary hemangioma that was causing amblyopia of the right eye from ptosis, globe displacement, and astigmatism. Forty-eight hours after the injection, the infant's parents noted that she was visually inattentive. On examination, she could not fixate or follow with either eye, and an afferent pupillary defect was present in the left eye. Ophthalmoscopy showed scattered areas of intraretinal hemorrhage in the right eye and extensive preretinal and intraretinal hemorrhages in the left eye. Ten months after injection, the hemangioma had greatly regressed, and visual acuity in the right eye was felt to be normal. The left eye had unsteady fixation with a persistent afferent pupillary defect and macular scarring. Retrograde flow of the corticosteroid suspension through the hemangioma's feeder vessels, probably originating from both ophthalmic arteries, is the most likely explanation for this complication.