Retinal Hemorrhage after Epiduroscopy in a Patient using Dexamethasone: A Case Report

Abstract

Epiduroscopy is a minimally invasive procedure used to diagnose epidural fibrosis and to release this fibrosis; epiduroscopy is also used to precisely deposit medication into the epidural space. It is commonly used in patients who are diagnosed with failed back surgery syndrome (FBSS) after more conservative treatment has failed to provide sufficient relief of symptoms. A rare complication of epiduroscopy is retinal hemorrhaging, which is likely caused by overpressurization of the epidural space during the procedure. Patient-related risk factors for developing retinal hemorrhage after epiduroscopy remain largely unknown. This is the first case report of retinal hemorrhage in a patient using chronic dexamethasone. We describe a 73-year-old man diagnosed with FBSS who underwent epiduroscopy to diagnose and relieve epidural fibrosis. The procedure was uneventful and he was discharged from our clinic the same day, but upon routine check-up he mentioned blurry vision. Immediately he was referred to an ophthalmologist who diagnosed retinal hemorrhages in both eyes upon fundoscopic examination. Our patient was using dexamethasone for the treatment of allergies. Three months after the procedure, his vision was restored fully in the right eye and 95% in the left eye. Chronic corticosteroid use may weaken retinal veins, making them prone to rupture when there is increased pressure, even for a short period of time. Chronic use of corticosteroids must be considered a risk factor for developing retinal hemorrhages in patients undergoing epiduroscopy. Long-term use of corticosteroid can be considered as a relative contraindication for epiduroscopy. Key words: Epiduroscopy, complications, interventional pain, corticosteroids, retinal hemmorhage, failed back surgery syndrome