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Concept: Amaurosis fugax

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With the increase in popularity of the use of cosmetic fillers in plastic and esthetic surgery, the possibility of severe ocular complications should not be neglected. Of the fillers used, autologous fat is the most common to cause permanent visual deterioration, one of the most severe complications associated with the use of cosmetic fillers. Here we present the first report of a complete recovery of visual acuity from an instance of visual loss with no light perception caused by ophthalmic artery occlusion of the right eye following autologous fat injection in the facial area. Immediate ophthalmological intervention and comprehensive therapy with prostaglandins and vinpocetine made it possible to restore retinal perfusion and achieve complete recovery of visual acuity. Awareness of the iatrogenic artery occlusions associated with facial fillers and the need for immediate treatment should be popularized among injectors to prevent devastating consequences, such as permanent vision loss. Level of Evidence V 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 .

Concepts: Evidence-based medicine, Visual perception, Visual acuity, Ophthalmology, Blindness, Cataract, Vision loss, Amaurosis fugax

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Carotid artery dissection is an uncommon entity associated with head and neck pain, partial Horner’s syndrome, amaurosis fugax, and brain ischemia, which may all occur in isolation or in combination. Herein, we report a rare case of cervical artery dissection in which pulsatile tinnitus was the only reported symptom. A 38-years-old man attended our hospital with a 4-days history of left side pulsatile tinnitus which began after stumbling. He had no other symptom. MRA showed luminal stenosis with pseudo lumen of the internal carotid artery. The patient was diagnosed with left internal carotid artery dissection and treated with antihypertensive therapy accordingly. After 2 months, the stenosis and tinnitus spontaneously resolved.

Concepts: Neurology, Internal carotid artery, Common carotid artery, External carotid artery, Internal jugular vein, Carotid artery dissection, Amaurosis fugax

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We report a modified operative technique termed partial eversion carotid endarterectomy (PECE). During a 9-year period (2006-2015), 352 patients underwent PECE. Indications for surgery, intraoperative details, and outcomes were recorded. The initial 185 patients had carotid duplex ultrasound imaging at 6 weeks and then at 6, 12, and 24 months. Subsequent patients had carotid imaging at 4 to 6 weeks. Indications included stroke (76), transient ischemic attack (153), and amaurosis fugax (33); 58 patients were asymptomatic, and 32 patients had surgery before cardiac surgery. Median clamp time was 14 minutes (interquartile range, 11.5-17 minutes). Median total operation time was 41 minutes (interquartile range, 31-72 minutes). Outcomes included four transient ischemic attacks (1.2%), five strokes (1.4%), and two deaths at 30 days (0.5%). No significant cranial nerve injuries or carotid restenosis was detected during follow-up. PECE is technically straightforward, with outcomes comparable to those of current operative techniques. Its advantages included reduced operative and carotid clamping time.

Concepts: Stroke, Transient ischemic attack, Interquartile range, Cranial nerves, Medical ultrasonography, Nerve, Carotid endarterectomy, Amaurosis fugax

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To describe the time course of management of patients with amaurosis fugax and analyze differences in management by different specialties.

Concepts: Medicine, Medical terms, Physician, Difference, Ophthalmology, Amaurosis, Amaurosis fugax

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The occurrence of amaurosis during ophthalmic anesthesia is well known. The reason for this manifestation has not been studied.

Concepts: Evoked potential, New Zealand, Evoked potentials, Amaurosis fugax

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The purpose of this study was to describe clinical characteristics and prevalence of carotid stenosis in patients with amaurosis fugax (AF).

Concepts: Epidemiology, Medical statistics, Neurology, Amaurosis, Ocular ischemic syndrome, Amaurosis fugax

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A man aged 77 years with postrenal transplant lymphoproliferative disease was admitted with high fever, elevated inflammatory markers and a heart murmur. Blood cultures grew Enterococcus faecalis and he was found to have mitral valve endocarditis on echocardiogram and subsequently started on appropriate antibiotics. 5 days into treatment, he developed ocular symptoms and 3 days later, he had irreversible monocular visual loss. He was seen by the ophthalmology team who diagnosed endogenous endopthalmitis secondary to bacteraemic spread from his endocarditis. Despite treatment with intravitreal antibiotics and prolonged systemic antibiotics, his sight did not recover. Although septic emboli are common in endocarditis, endogenous endophthalmitis is rarely reported and frequently results in visual loss. Early treatment confers an improved prognosis.

Concepts: Inflammation, Diseases and disorders, Heart, Mitral valve prolapse, Blindness, Cataract, Enterococcus faecalis, Amaurosis fugax

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Acute visual loss is a frightening experience, a common ophthalmic emergency, and a diagnostic challenge. In this review, the author focusses on the diagnosis of transient monocular blindness and visual loss due to infarction of the retina and/or the optic nerve-the ocular parallel of cerebral stroke.

Concepts: Myocardial infarction, Atherosclerosis, Hypertension, Stroke, Optic nerve, Blindness, Vision loss, Amaurosis fugax

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A 49-year-old woman developed acute visual loss in the right eye following bilateral cosmetic platelet-rich plasma injections to rhytids in the glabellar region. External exam showed skin necrosis in the region over the right rhytids and restricted right ocular motility. Dilated fundus exam was significant for ophthalmic artery occlusion. Imaging revealed right eye extraocular muscle ischemia and optic nerve infarction, along with right frontal, parietal, and occipital lobe infarction. Work-up for thromboembolic and vascular etiologies were negative. To our knowledge, this is the first case reported of extensive ischemia following autologous platelet-rich plasma therapy.

Concepts: Snake scales, Visual system, Ophthalmology, Necrosis, Optic nerve, Vision loss, Dilated fundus examination, Amaurosis fugax

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