Frontal Sinus Cyst Surgery Complicated By Central Retinal Artery Occlusion - Frontal Sinus Cyst Surgery Complicated By Central Retinal Artery Occlusion - Open Access Pub

Central retinal artery occlusion (CRAO) is a retinal ischemic disorder associated with sudden loss of vision and has a poor prognosis. We report a case of CRAO that occurred during frontal sinus surgery involving craniotomy in a patient with a frontal sinus cyst. The prognosis for treatment after the acute phase is generally unfavorable; however, aggressive treatment is recommended for patients with visual acuity of “hand motion” or better within 1 day after onset. This case highlights the need for informed consent prior to nasal or paranasal sinus surgery, including mention of the possibility of CRAO as a complication. DOI10.14302/issn.2379-8572.joa-14-531 Central retinal artery occlusion (CRAO) is a retinal ischemic disorder associated with sudden loss of vision and has a poor prognosis. Loss of vision is caused by vessel occlusion leading to ischemic injury affecting nerve cells (ganglion, amacrine, and bipolar cells) that line the retina. CRAO is often associated with vascular thrombotic events. It usually occurs in elderly patients with hypertension or diabetes, but may also develop due to retrobulbar anesthesia, as a complication of optic neuritis, or during surgery.1, 2, 3 Here, we report a case of CRAO that occurred during frontal sinus surgery with craniotomy in a patient with a frontal sinus cyst. A 57-year-old man had presented 12 years earlier with left upper eyelid swelling, was diagnosed with frontal sinusitis, and underwent surgery at another hospital. Craniotomy was performed with removal of the left frontal bone and placement of a ceramic implant. The subsequent clinical course was uneventful. However, on February 3, 2007, he again experienced left upper eyelid swelling and pain that was evaluated at a local clinic. Antibiotics were prescribed. Recurrent frontal sinusitis was suspected, and the patient was referred to our department for evaluation on February 14, 2007. On initial evaluation, the left upper eyelid swelling was resolved; however, paranasal sinus computed tomography (CT) showed two left frontal sinus cysts (Figure 1). The patient had a history of hypertension that was well-controlled on oral medications. No other major disorders were present, including diabetes or heart disease. Figure 1. CT of the paranasal sinuses showed two left frontal sinus cysts. Black arrows: ceramic implant. Black stars: two left frontal sinus cysts On April 28, 2007, craniotomy was performed under general anesthesia, with removal of the ceramic implant and median drainage of the frontal sinus (Figure 2). Two cysts in the left lateral frontal sinus