Ophthalmic complications after the embolization of the internal carotid artery--a case report
The case report concerns about a 53 years old lady with Rendu-Osler-Weber disease, who was referred to our Department with the orbital apex syndrome after embolization of the internal carotid artery (ICA) due to repeating epistaxis. Immediately after the surgical procedure concerning the left-sided ICA, the patient complained about sharp hemicrania and pain of the ipsilateral eye, and diminished vision as well. The neurological and ophthalmologic examinations found decreased vision and limited movement of the eyeball on the left side. The patient was handed over to our Department inpatient care after one week after the surgery with clinically expressed syndrome of the left orbital apex--amaurosis, ptosis, total ophthalmoplegia, and protrusion of the eyeball. During the stay in the hospital, the progression of scotomas of the visual field with remaining concentric visual field on the right side (i.e. contralateral to the procedure) was found. The central vision of the right eye remained 20/20. The patient was treated by means of corticosteroids systemically as well as locally. The signs gradually subsided; during the control stay in hospital after three weeks after the surgery, the movements were limited in the far periphery only; slight ptosis and internal ophtalmoplegia remained; no protrusion of the eyeball was present; the amaurosis of the left eye remained permanent. In the visual field of the right eye, the concentric restriction disappeared and slight depression in the nasal half of the visual field remained only.