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1、CASEREPORTS病理报告Irreversible Blindness Following Periocular Autologous Platelet-Rich Plasma Skin Rejuvenation Treatment 不可逆转的失明之后眼周的自体富含血小板等离子皮肤再生疗法Krishnapriya Kalyam, M.D., Shaheen C. Kavoussi, M.D.,Michael Ehrlich, M.D., Christopher C. Teng, M.D.,Nisha Chadha, M.D., Sarah Khodadadeh, M.D.,and Ji L
2、iu, M.D.Krishnapriya Kalyam,医学博士卡佛西，夏新，医学博士， 迈克尔埃利希。克里斯托弗c 腾医学博士， 尼莎查达医学博士莎拉Khodadadeh，医学博士， 和刘霁,医学博士Abstract: 摘要：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 ski
3、n 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 infarct
4、ion. 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.49岁的妇女发展敏锐的视力丧失在双边整容后的右眼富含血小板等离子体注入rhytids在眉间的地区。 外部检查在该地区显示皮肤坏死rhytids和限制对眼部的能动性。扩张眼底检查是重要的眼动脉阻塞。成像 显示右眼眼外
5、肌缺血和视神经梗塞,右额叶,顶叶,和枕叶梗死。血栓栓塞的诊断检查和血管性病因是负的。 据我们所知,这是第一例报道广泛的缺血自体富含血小板血浆治疗。CASE REPORT 病理报告The case reported here is in compliance with the Health Insurance Portability and Accountability Act (HIPAA) regulation. An otherwise healthy 49-year-old woman presented to the Yale Eye Center complaining of acu
6、te loss of vision in the right eye associated with severe nausea and eye pain. One day prior, the patient underwent an autologous platelet-rich plasma (APRP) injection procedure by an unlicensed practitioner to reduce wrinkles in the glabellar region bilaterally. She reported that blood was taken fr
7、om her antecubital region by venous puncture and centrifuged to obtain concentrated autologous plasma. Bilateral forehead rhytids injections were performed. The patient was unaware the details of the plasma preparation and the size of needle that was used for injections. She tolerated the first inje
8、ction on the left side well. However, during the second injection at the nasal end of right eyebrow, she felt the needle penetrate slightly deeper, accompanied by sudden pain and fullness behind her right eye with immediate visual loss over the next few minutes. She then noted transient improvement
9、of vision in nasal field followed by complete loss of vision.这里的案例报告是符合健康保险流通与责任法案(HIPAA)监管。一个原本健康的49岁的女人向耶鲁大 学眼科中心抱怨急性右眼失明与严重的恶心和眼睛疼。一天之前，病人接受了自体富含血小板血浆(APRP)注 射过程无证医生减少皱纹双边眉间的地区。报道称,血从她的肘前的区域通过静脉穿刺和离心获得浓缩自体 血浆。双边额头 rhytids 注射进行。病人不知道等离子体的细节准备和用于注射针的大小。她容忍第一注入 在左边。然而,在第二次注射年底鼻右眉,她觉得针穿透略深,伴随着她身后突然疼痛
10、和丰满的右眼立即视觉 损失在接下来的几分钟。然后她指出瞬态改善视力在鼻领域完全失明。On examination, vision was no light perception in the right eye and 20/20 in the left eye. A pronounced right afferent pupillary defect was present. Motility of the right eye was restricted in supraduction and adduction resulting in a right exotropia and hyp
11、otropia in primary gaze. External exam demonstrated a 1cm area of ecchymosis and induration above the right medial brow. The eyelids were soft and there was no proptosis or resistance to retropulsion. Anterior segment exam was unremarkable in both eyes except moderate conjunctival hyperemia in the r
12、ight eye. Intraocular pressure was within normal limits bilaterally. Fundus exam of the right eye revealed profound optic disc pallor, diffuse retinal whitening including fovea, marked attenuation of arterioles with abrupt ending of the vessels in midperiphery, and central macular edema. Absence of
13、a cherry red spot suggested diffuse choroidal ischemia. No Hollenhorst plaque was seen. The left fundus exam was unremarkable.检查,视觉上没有光感觉右眼和左眼的 20/20 。发音正确的瞳孔传入障碍。右眼的能动性是限制supraduction和内收导致右外斜视，在主要的目光下斜视。外部考试了 1厘米面积瘀斑和硬化上面正确的内 侧的额头。眼皮都软,没有突出或抵抗后退。前部分是毋庸置疑的双眼除了右眼温和的结膜充血。眼压在正 常范围内双边。眼底检查的右眼揭示深刻的视觉阀瓣苍白
14、,弥漫性视网膜美白包括中央窝,明显衰减的小动 脉血管的突然结束midperiphery,中央黄斑水肿。缺乏一个樱桃红斑建议分散脉络膜缺血。没有Hollenhorst 斑块是观察。左眼底是毋庸置疑。Head and neck CT showed right subacute frontal lobe ischemia without identifiable compromised vessels.MRI/MRA of brain and orbit demonstrated restricted diffusion along the course of the right optic ner
15、ve and multiple subacute infarcts involving right frontal, parietal, and occipital lobes (Fig. 1). Asymmetric abnormal FLAIR/T2 signal of the right medial rectus muscle was suggestive of ischemia (Fig. 2). Bone marrow edema within the right frontal bone with irregular enhancement involving the overl
16、ying skin was also shown. MRA of the brain and neck was negative for cavernous sinus pathology, or vertebral or carotid artery dissection. CTA of the head and neck and transthoracic echocardiogram identified no embolic origin. Echocardiogram and carotid dopplers were negative.头部和颈部CT显示右亚急性额叶没有识别受损血管缺血。MRI和MRA的脑部和轨道证明限制扩散沿 正确的视神经和多个亚急性梗死涉及右额叶、顶叶、枕叶图1)。不对称异常天赋/ T2信号右侧内直肌的提 示缺血(图 2)。右额骨内骨髓水肿与不规则增强涉及覆盖皮肤也显示。 MRA 的大脑和颈部是消极的海绵窦 病理学，或椎或颈动脉解剖。CTA的头部和颈部和经胸廓的
