Branch Retinal Artery Occlusion Research Articles

Incomplete susac syndrome

Susac syndrome (SS) is a rare disease affecting the microvasculature of the inner ear, brain, and retina, which usually presents with the triad of hearing loss, encephalopathy, and branch retinal artery occlusions. This condition usually affects young women and treatment consists, in most cases, of immunosuppression. In this article, we report the case of a 35-year-old female patient with an incomplete SS, with visual and hearing manifestations.

Anterior ischemic optic neuropathy and branch retinal artery occlusion: An uncommon finding in thalassemia minor

The minor thalassemia has always been considered as an asymptomatic disease in the majority of cases. However, according to the literature, the poor chronic retinal perfusion related to a minor thalassemia can produce ocular manifestations as venous occlusion and ischemic retinopathy, especially in the presence of other risk factors. This short report describes a rare observation of a patient with an anterior ischemic optic neuropathy and branch retinal artery occlusion revealing a minor beta-thalassemia.

Clinical Diagnosis, Classification and Differential Diagnosis in Retinal Artery Occlusion

A retinal artery occlusion is an ophthalmic emergency requiring immediate systemic evaluation because it is a summoner to stroke. Diagnosis is usually prompted by the patient’s history and fundus examination. Fundus fluorescein angiography (FFA) and optical coherence tomography are routinely used in clinical evaluation. Retinal artery occlusions are clinically classified as central retinal artery occlusion (CRAO), branch retinal artery occlusion (BRAO), cilioretinal artery occlusion (CLRAO), combined retinal artery and vein occlusion, cotton-wool spots and a newly defined entity paracentral acute middle maculopathy (PAMM).

Inflammatory branch retinal artery and vein occlusion with panuveitis secondary to dengue fever.

Inflammatory branch retinal artery and vein occlusion with panuveitis secondary to dengue fever.

Development of visual acuity under hyperbaric oxygen treatment (HBO) in non arteritic retinal branch artery occlusion

Nonperfusion of retinal tissue due to arterial occlusion leads inevitably to mostly irreversible retinal damage. Until today no evidence-based treatment exists. Inhalation of 100% oxygen at high atmospheric pressure causes an increased solubility of oxygen in the blood that helps the retinal tissue to survive through diffusion in case of an artery occlusion till vascular recanalization occurs. Hence the purpose of this study is to compare the visual outcome in patients with retinal branch artery obstruction treated with hyperbaric oxygen versus patients treated with hemodilution only. Non-randomized, monocentric, retrospective study. Patients with diagnosis of non-arteritic retinal branch artery occlusion (BRAO) treated with hyperbaric oxygen therapy between 1997 and 2017. Exclusion criteria were central retinal artery occlusion, presence of a cilioretinal artery and arteritic cases. The control group was matched based on visual acuity (VA) at admission, age, and delay between symptoms and beginning of clinical care. The control group and the matching oxygen group contained 14 patients each. Initial VA in the matched HBO group was 0.18 ± 0.19 and 0.23 ± 0.19 in the control group (p = 0.57). Final VA at discharge was 0.69 ± 0.29 in the matched oxygen group and 0.32 ± 0.23 in the control group (p = 0.0009). HBO-treated patients had a significant visual increase compared with the control group. The most common comorbidities were arterial hypertension and vascular sclerosis. HBO treatment appears to have a beneficial effect on visual outcome in patients with retinal branch artery occlusion. HBO treatment could be a rescue therapy at an early stage of BRAO, especially to bridge the time of a potential reperfusion. However, further, prospective, randomized clinical trials are required to verify this assumption.

Vision Loss Associated with Hyaluronic Acid Fillers: A Systematic Review of Literature.

With the global increase in the use of injectable fillers, more cases with serious adverse events such as skin ischemia and vision loss are being reported. This article aims to review the role of HA fillers, as a subgroup separate from fat graft and non-HA fillers, in causing vision loss and to elucidate various features and outcomes of post-HA filler vision loss. The preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines were used to report this review. A total of 29 articles presenting 60 unique cases of post-HA filler vision loss were identified in the literature. Based on various inclusion and exclusion criteria, 26 articles with details of 44 cases were included in this study. The majority of cases were seen in women and in the 20-40years age group. The maximum number of cases was reported from Korea, followed by China. Nearly half of the cases reported after HA filler-related visual complications had partial loss of sight, hence 'partial vision loss' and 'complete vision loss' were used as differentiating descriptive terms to the degree of 'blindness.' Nearly all the cases were unilateral, with immediate onset of visual signs and symptoms. The nose, glabella, and forehead were the most commonly implicated areas, while no cases of post-HA filler vision loss were reported from lower face anatomical areas, including the chin, jawline, and lips. Partial vision loss after HA filler has a better prognosis than complete vision loss. HA filler volumes as low as 0.2ml can cause permanent, complete vision loss, which is suggestive of the embolic nature of HA filler blockage. Ophthalmic artery occlusion (OAO) and central retinal artery occlusion (CRAO) were the two most commonly involved arterial obstruction patterns followed by branch retinal artery occlusion (BRAO). BRAO is the most favorable involved arterial pattern for a chance of recovery after HA filler-related vision loss while CRAO and OAO patterns carry a very poor prognosis. Post-HA filler vision loss is nearly always of immediate onset. Partial vision loss after HA filler injection with the involvement of smaller branches of the retina, other than central retinal artery or ophthalmic artery, has more favorable visual outcomes. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Various Retinal Vascular Manifestations of Neurofibromatosis-1 in a Single Patient

Objectives: To report an Iranian woman with a variety of retinal vascular manifestations secondary to Neurofibromatosis -1.Case Report: A 49 years old woman known case of Neurofibromatosis-1 (NF-1) presented with decreased vision in her right eye. We found peculiar retinal and choroidal findings. Mild vascular tortuosity and few hard exudates were the prominent finding in right eye fundus examination; however, left eye showed inferior hemi retinal artery macro aneurysm. Fluorescein angiography, revealed multiple bright choroidal nodules in both eyes. Left eye findings were in favor of branch retinal artery occlusion and branch retinal vein occlusion. Discussion: As vascular and microvascular manifestations of NF-1 are being reported recently, further investigational studies for retinal vascular associations in NF-1 patients appears reasonable. Complete ophthalmic examinations in each NF-1 patient seems essential to prevent potential threatening complications of vascular events in these patients.

Non-arteritic anterior ischemic optic neuropathy with Cilioretinal artery occlusion: a case report

BackgroundTo describe a peculiar case of concurrent non-arteritic anterior ischemic optic neuropathy (NAION) and cilioretinal arteries occlusion (CLRAO) without other causative agents which responded well to intravenous and intravitreal injection of corticosteroids.Case presentationA 41-year-old woman presented with painless vision loss in the right eye for 1 week. Fundus examinations showed marked disc swelling, flame-shaped hemorrhage over the superior nerve fiber area, and well-demarcated retinal ischemia superior to the fovea in the right eye. Under the impression of NAION with branch retinal artery occlusion, the patient was treated with intravenous and intravitreal injection of corticosteroids. Two months later, as the disc swelling and retinal ischemia resolved, we found that the occluded artery was the cilioretinal artery and not the ordinary branch retinal artery.ConclusionsCLRAO may be concomitant with the setting of NAION, the physicians should be aware that CLRAO may be misinterpreted as BRAO owing to profound disc edema during the early stages of the disease.

Brain microvascular pathology in Susac syndrome: an electron microscopic study of five cases

ABSTRACTSusac syndrome is a rare, immune-mediated disease characterized by encephalopathy, branch retinal artery occlusion, and hearing loss. Herein, we describe the electron microscopic findings of three brain biopsies and two brain autopsies performed on five patients whose working clinical diagnosis was Susac syndrome. In all five cases, the key findings were basement membrane thickening and collagen deposition in the perivascular space involving small vessels and leading to thickening of vessel walls, narrowing, and vascular occlusion. These findings indicate that Susac syndrome is a microvascular disease. Mononuclear cells were present in the perivascular space, underlining the inflammatory nature of the pathology. Though nonspecific, the changes can be distinguished from genetic and acquired small vessel diseases. The encephalopathy of Susac syndrome overlaps clinically with degenerative and infectious conditions, and brain biopsy may be used for its diagnosis. Its vascular etiology may not be obvious on light microscopy, and electron microscopy is important for its confirmation.

Safety analysis of branch arteries covered by Tubridge flow diverters in treatment of intracra-nial aneurysms

Objective To evaluate the safety of branch arteries covered by Tubridge flow diverters (TFDs) in the treatment of intracranial aneurysms. Methods The clinical and angiographic data of 79 patients harboring 79 aneurysms treated with TFD from the Parent Artery Reconstruction for Large or Giant Cerebral Aneurysms Using Tubridge (PARAT) trials were retrospectively collected and analyzed, in which 12 nationwide centers participated from December 2012 to May 2014. Digital subtraction angiography (DSA) was performed to evaluate immediate treatment results and coverage of branch vessels. For aneurysms treated by TFDs and coils, immediate results were classified according to Raymond Grade System, and for aneurysms treated by TFDs only, immediate results were evaluated according to stagnation of contrast. Angiographic follow-up was preformed conventionally after treatment with TFDs at 3 months using magnetic resonance angiography (MRA)and 6 months using DSA. Results A total of 91 TFD were delivered and implanted successfully in the 79 lesions. Fifty-eight aneurysms were treated by TFDs and coils, and Raymond Ⅰwas achieved in 2 lesions (3.4%), Raymond Ⅱ in 5 lesions (8.6%) and Raymond Ⅲ in 51 lesions (87.9%). For 21 aneurysms treated by TFDs alone, stagnation of contrast was observed in 15 lesions (71.4%). One hundred and ten branch arteries were covered by TFDs. MRA was available in 52 patients at 3 months, and 31 lesions (59.6%) were completed cured, 16 lesions (30.8%) were improved and 5 lesions (9.6%) remained stable. DSA data were available in 73 patients at 6 months. Among them, 55 (75.3%) were completed cured, 14 (19.2%) were improved, 2 (2.7%) remained stable and 2 (2.7%) developed recurrence. The total rate of effective treatment (completely cured and improved) was 94.5% (69/73). Branch artery occlusion was observed in 3 cases, including 1 anterior choroidal artery, 1 anterior cerebral artery and 1 ophthalmic artery, without permanent neurologic deficits. The occlusion rate of branch arteries was 2.9% (3/104). Conclusion Branch arteries covered by Tubridge flow diverter in treatment of intracranial aneurysms seem relatively safe and further clinical follow-up is needed. Key words: Intracranial aneurysm; Flow diverter; Safety

Symmetrical Hollenhorst Emboli with Branch Retinal Artery Occlusion

Symmetrical Hollenhorst Emboli with Branch Retinal Artery Occlusion

RASH PROVOKES CATASTROPHIC ANTIPHOSPHOLID SYNDROME

SESSION TITLE: Wednesday Medical Student/Resident Case Report Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: 10/23/2019 09:45 AM - 10:45 AM INTRODUCTION: Catastrophic Antiphospholipid Syndrome (CAPS) is a rare life-threatening condition characterized by acute thrombosis in multiple organ systems leading to ischemia and/or organ failure in the presence of positive antiphospholipid antibodies. Approximately fifty percent of patients who present with CAPS do not initially have a prior diagnosis of antiphospholipid syndrome. We present a case of a patient who was found to have CAPS after originally presenting to the hospital for a drug induced rash. CASE PRESENTATION: A 55-year-old male with psoriasis presented to the hospital with a painful diffuse erythematous and pustular rash covering his entire body two days after receiving general anesthesia and cefazolin for an elective circumcision. He was admitted to the burn unit and punch biopsy revealed Acute Generalized Exanthematous Pustulosis (AGEP). Two days after his initial presentation, he lost vision in his right eye and was found to have an acute branch retinal artery occlusion. Throughout the next day, he became hypotensive, somnolent, and confused and he was found to have a dilated right pupil. Imaging revealed a left middle cerebral artery stroke. He developed acute renal failure and a non-ST-elevation myocardial infarction. He was started on pressor support for shock and ultimately required intubation due to increased work of breathing. Autoimmune and vasculitis workup were unremarkable. Repeat MRI was performed which revealed three new infarcts in the right frontal lobe and basal ganglia. Due to concern for endocarditis, a transesophageal echocardiogram was performed and was negative for vegetation. Bilateral lower extremity ultrasound was negative for deep venous thrombosis. Thrombotic workup was remarkable for a positive lupus anticoagulant, hexagonal phase phospholipid, and dilute Russell’s viper venom time screen. He was treated with methylprednisolone, plasma exchange, and a heparin infusion for suspected Catastrophic Antiphospholipid Syndrome. His overall condition began improving within 24 hours and he was eventually extubated. DISCUSSION: CAPS is difficult to diagnose with a need for high clinical suspicion especially in the setting of concomitant illnesses. For this patient with AGEP after cefazolin use, clinical diagnosis became even more difficult as the patient had such significant physical exam findings. Fortunately, the patient was diagnosed quickly enough to receive proper treatment and have significant improvement. CONCLUSIONS: This case demonstrates the importance of a high clinical suspicion to facilitate and receive prompt treatment with plasma exchange and a heparin infusion in order to improve a patient's chances of survival given the increased morbidity and mortality associated with CAPS. Reference #1: Nayer A, Ortega LM. Catastrophic antiphospholipid syndrome: a clinical review. J Nephropathol. 2014;3(1):9-17. DISCLOSURES: No relevant relationships by Nathan Brewster, source=Web Response No relevant relationships by Aaron Czysz, source=Web Response No relevant relationships by Kareem Godil, source=Web Response No relevant relationships by Breanna Goldner, source=Web Response No relevant relationships by Alaynna Kears, source=Web Response

Detection of Multi-Class Retinal Diseases Using Artificial Intelligence: An Expeditious Learning Using Deep CNN with Minimal Data

The health-related complications such as diabetes, macular degeneration, inflammatory conditions, ageing and fungal infections may cause damages to the retina and the macula of the eye, leading to permanent vision loss. The major diseases associated with retina are Arteriosclerotic retinopathy (AR), Central retinal vein occlusion (CRVO), Branch retinal artery occlusion (BRAO), Coat's disease (CD) and Hemi-Central Retinal Vein Occlusion (HRVO). The symptomatic variations among these disorders are relatively confusing so that a systematic diagnostic strategy is difficult to set in. Therefore, an early detection device is required that is capable of differentiating the various ophthalmic complications and thereby helping in providing the right treatment to the patient at the right time. In this research work, 'Deep Convolution Neural Networks (Deep CNN) based machine learning approach has been used for the detection of the twelve major retinal complications from the minimal set of fundus images. The model was further cross-validated with real-time fundus images. The model is found to be superior in its efficiency, specificity and ability to minimize the misclassification. The “multi-class retinal disease” model on further cross-validation with real-time fundus image of the gave an accuracy of 95.63 %, validation accuracy of 92.99 % and F1 score of 91.96 %. The multi-class model is found to be a theranostic clinical support system for the ophthalmologist for diagnosing different kinds of retinal problems, especially BRAO, BRVO, CRAO, CD, DR, HRVO, HP, HR, and CN.

Analysis of clinical features of ophthalmic and cerebral artery occlusion after facial cosmetic injection

Objective To observe the clinical characteristics of ophthalmic and cerebral artery occlusion after facial cosmetic injection. Methods A retrospective case study. Twenty patients (20 eyes) with ophthalmic and cerebral artery occlusion in Department of Ophtalmology, The Fourth Hospital of Xi’an from February 2014 to December 2016 were enrolled in this study. There were 2 males (2 eyes) and 18 females (18 eyes). They aged from 21 to 41 years, with the mean age of 29.8±1.4 years. The disease courses was ranged from 3.5 hours to 21 days, with the mean of 40 hours. Facial cosmetic injections of all patients were performed at out-of-hospital beauty institutions. The visual impairment was associated with eyelid pain 1 to 10 minutes after injection.There were 12 right eyes and 8 left eyes.The injection materials, 18 patients were hyaluronic acid and 2 patients were autologous fat, respectively. At the injection site, 13 patients were sacral, 4 patients were nasal, and 3 patients were frontal. The concentration and dose of the injected filler were not known. All patients underwent vision, slit lamp microscope, fundus color photography, visual field, FFA, OCT, and brain CT, magnetic resonance angiography (MRA) examination. Results The visual acuity was ranged from no light perception to 1.0. Among the 20 eyes, 3 eyes (15%) were obstructed by simple ophthalmic artery; 5 eyes (25%) were obstructed by ophthalmic artery combined with cerebral artery; 7 eyes (35%) were obstructed by simple retinal artery occlusion (RAO) alone, which including central RAO (CRAO, 4 eyes), hemi-lateral artery obstruction (1 eye) and branch RAO (2 eyes); 1 eye (5%) was CRAO with ciliary artery branch obstruction; 1 eye (5%) was branch artery occlusion with ischemic optic neuropathy; 2 eyes (10%) were CRAO with nasal dorsal artery occlusion; 1 eye (5%) was CRAO, posterior ciliary artery obstruction and right middle cerebral artery occlusion. Among 20 patients, 4 patients (20%) had eye movement disorder and eyelid skin bun; 2 patients (10%) had facial pain and nasal skin ischemic necrosis. MRA revealed 6 patients (30%) of new intracranial ischemic lesions. Among them, 5 patients of hyaluronic acid injection showed asymptomatic small blood vessel embolization; 1 patient of autologous fat injection showed ophthalmary artery occlusion, cerebral artery occlusion, ipsilateral eye blindness, eye movement disorder and contralateral limb hemiplegia. Conclusion Facial cosmetic injection can cause severe iatrogenic complications such as RAO, ciliary artery occlusion, ischemic optic neuropathy, ophthalmic artery occlusion, and cerebral artery occlusion. Key words: Retinal artery occlusion; Ciliary arteries occlusion; Cerebral artery occlusion; Facial cosmetic injection

Preclinical Evaluation of the Accero Stent: Flow Remodelling Effect on Aneurysm, Vessel Reaction and Side Branch Patency.

It has been hypothesized that microstents which are used to prevent coil protrusion in the treatment of cerebral aneurysms may have flow diverting and therefore occlusive effects. In a rabbit elastase aneurysm model, we investigated the aneurysm occlusion rate and vessel reaction of a braided Accero stent prototype with porosity in the lower range of other available (non-flow-diverter) microstents. Ten aneurysms were induced the right subclavian artery in New Zealand white rabbits and treated with the Accero stent prototype. In each subject, a second stent was implanted in the abdominal aorta to cover the origins of branch arteries. Angiographic follow-up and explantation of the devices and aneurysms for histological analysis were performed after 3months (n = 5) and 6months (n = 5). Grades I (< 50%) and II (> 50%) occlusion rates were observed in 9 (90%) and 1 (10%) of ten aneurysms treated with the stent device. The mean reduction in contrast filling at 6months was 42.1% (p = .02). Neointima thickness was significantly higher in the subclavian artery than in the abdominal aorta after 3 (p = .03), whereas not after 6months (p = .1). No cases of inadequate wall apposition, branch artery occlusion or stent thrombosis were observed. The present study showed flow remodelling properties of the device prototype with progredient aneurysm occlusion. A larger in vivo study with induced aneurysm should be done to confirm these results.

Risk of acute stroke in patients with retinal artery occlusion: a systematic review and meta-analysis.

To estimate the incidence of acute cerebral ischaemia detected by magnetic resonance imaging (MRI) in acute central retinal artery occlusion (CRAO), branch retinal artery occlusion (BRAO) and transient monocular vision loss (TMVL). Studies reporting the incidence of acute cerebral ischaemia, detected by MRI, within 7 days from diagnosis of acute CRAO, BRAO and TMVL up to January 2019 were systematically searched for on Pubmed, Medline and Cochrane Library. Meta-analysis was performed using random effects model. The primary outcome was the pooled estimate of incidence of acute cerebral ischaemia in CRAO, BRAO and TMVL cohorts including both neurologically symptomatic and asymptomatic patients, expressed as a proportion along with 95% confidence intervals (CIs). The pooled estimate of incidence of asymptomatic acute cerebral ischaemia represented a secondary outcome measure. For the primary outcome, the pooled proportion of acute cerebral ischaemia was 0.30 (CI 0.24-0.36) in the CRAO cohort, and 0.25 (CI 0.16-0.37) in the BRAO cohort, without statistical heterogeneity. The rate of acute cerebral ischaemia was 11.8% in the TMVL cohort. For the secondary outcome, the pooled proportion of asymptomatic acute cerebral ischaemia was 0.22 (CI 0.16-0.28) in the CRAO cohort, 0.29 (CI 0.20-0.41) in the BRAO cohort and 0.08 (CI 0.05-0.15) in the TMVL cohort, with no statistical heterogeneity. 30% of patients with acute CRAO and 25% of patients with acute BRAO presented an acute cerebral ischaemia on MRI. Such high rates support a care pathway of prompt referral of such patients for neurological evaluation and brain imaging.

Branch Retinal Artery Occlusion Following Intravitreal Injection of Methotrexate for the Treatment of Primary Vitreoretinal Lymphoma

Purpose: This paper reports a case of an older white woman presenting with recalcitrant bilateral vitreoretinal inflammation that was ultimately proven to be primary vitreoretinal lymphoma by vitreous biopsy who subsequently developed a branch retinal artery occlusion (BRAO) following an intravitreal injection of methotrexate. Methods: Case summary. Results: The patient was treated with serial intravitreal methotrexate injections and subsequently developed a BRAO immediately following her seventh injection. Conclusions: A full systemic evaluation to rule out other causes of the BRAO was negative and given the timing of her symptoms after the injection it was determined that the BRAO was most likely realted to the intravitreal methotrexate injection.

Prediction of the extent of thrombus formation in the parent artery after endovascular occlusion of a distal anterior cerebral artery aneurysm using computational fluid dynamics

Endovascular coiling of a cerebral aneurysm and coil occlusion of the parent artery have been occasionally performed to treat cerebral aneurysms; however, it is difficult to predict the accurate extent of thrombus formation in the parent artery proximal to the coiled aneurysm and the coil-occluded parent artery preoperatively, and unexpected occlusion of the arterial branches can occur by thrombus extension into or in the parent artery. The authors describe a case of a distal anterior cerebral artery (ACA) aneurysm treated by endovascular parent artery occlusion (PAO) with preoperative computational fluid dynamics (CFD) prediction of the extent of thrombus formation. A 73-year-old woman presented with subarachnoid hemorrhage and an aneurysm that was located on the right pericallosal artery distal to the paracentral artery bifurcation. Endovascular coiling of the aneurysm and the pericallosal artery was planned. In advance of the treatment, CFD was performed to predict the extent of thrombus formation with specific wall shear stress and shear rate thresholds. The hemodynamic results indicated that coiling of the aneurysm resulted in thrombus formation in the pericallosal artery up to just distal to the paracentral artery ostium; therefore, the treatment was implemented according to the CFD prediction. Postoperative digital subtraction angiography revealed that the extent of thrombus formation was consistent with the preoperative CFD prediction. This technique may prevent unexpected occlusion of arterial branches.

320.4: Use of Arterial Embolisation to Facilitate Exenteration during Multi-visceral and Intestinal Transplantation

Introduction: Exenteration during multi-visceral and intestinal transplantation is associated with significant blood loss that increases patient instability intra-operatively and may affect the subsequent post-operative course. This is particularly the case for multi-visceral transplantation (MVT) for porto-mesenteric thrombosis (PMVT). Methods: Embolisation was undertaken in theatre following anaesthesia and placement of lines. Amplatzer arterial plugs (St Jude), either type I (8mm in length) or type II (16–24 mm) were utilised. In the case of full MVT, the plugs occluded both coeliac axis (CA) and superior mesenteric arteries (SMA). In circumstances where the stomach was retained the SMA, hepatic and splenic arteries were occluded and the left gastric artery preserved. Results: Pre-operative embolisation was performed in 13 patients who have had either MVT, liver/small bowel transplant (LSB), or small bowel/ pancreas/colon transplant (SBP). Nine of the 13 cases were embolised for severe portal hypertension (PHT). We have compared blood loss and use of blood products in this group to a historical cohort of intestine containing transplants in patients with severe PHT (table 1). By performing embolisation in the operating theatre there was minimal delay in the explant procedure and no increase in the cold ischaemic time. There was a reduction in intra-operative blood loss, blood products and metabolic instability. One patient undergoing a full MVT for PMVT required no blood products intra-operatively. There were no complications associated with the embolisation procedure. Conclusion: We believe that arterial embolisation is a very useful technique to minimize the blood loss associated with severe PHT during intestine containing transplantation. It reduces blood loss, blood products and metabolic instability. The use of arterial plugs substantially reduces the time required for embolisation and the selective occlusion of visceral arterial branches allows for the preservation of the stomach.

Known and novel ocular toxicities of biologics, targeted agents, and traditional chemotherapeutics.

Increases in cancer with an aging population and the rapid development of new chemotherapeutics underscore the need for ophthalmologists to identify and manage potential ocular toxicities. This retrospective case series reports the ocular side effects of traditional and novel chemotherapeutic agents from a large center. The medical records of 3537 adult patients 18years and older who presented to an academic ophthalmology department on high-risk medications identified by ICD-9 search between January 2010 and February 2015 were reviewed. A cancer diagnosis, as well as a temporal association with chemotherapeutic use and ocular side effect, was deemed necessary for inclusion in the study. The main measures were ocular side effects in cancer patients taking chemotherapy, ocular imaging abnormalities, and the outcome of each side effect. Of the 161 oncology patients referred to the ophthalmology clinic for chemotherapeutic screening or ocular side effect, 31 (19.3%) were identified as having an ocular adverse reaction due to a novel or traditional chemotherapeutic medication. A novel flattening of the corneal curvature with hyperopic shift and corneal microcysts was identified in a patient taking the antibody-drug conjugate mirvetuximab soravtansine and was reversible with topical steroids. A bilateral medium-vessel choroidal vasculopathy with serous retinal detachment was seen with ipilimumab. The most frequent medication with ocular toxicity was interferon-α(2b) (IFN-α(2b)) (6/31, 19.4%); headache was typical in these patients (83.3%). Ibrutinib ocular toxicity was second most common (5/31, 16.1%), usually causing red or dry eye, while one patient developed branch retinal artery occlusion. Retinal abnormalities documented on OCT imaging occurred with IFN-α(2b), ipilimumab, binimetinib, and docetaxel, while rod-cone ERG abnormality was seen with cisplatin. Inflammatory conditions included anterior scleritis with zoledronic acid, focal eyelid inflammation with veliparib, bilateral chemosis with R-CHOP, iritis, and blepharospasm with IFN-α(2b). AION occurred with pemetrexed, and transient vision loss with hyperemic disc OS was seen with FOLFOX. Two patients (2/31, 6.5%) developed permanent vision loss. Six patients were lost to follow-up, and the clinical course was unknown (6/31, 19.4%). Cases of permanent visual loss were observed; yet, in the majority of side effects, they improved with topical therapy and/or holding the medication. Further research is needed to elucidate the incidence and the pathophysiology of these side effects and maximize patient quality of life.