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Mehta N, Rajagopal U. Delayed-Onset Idiopathic Intracranial Hypertension After Liposuction: A Case Report and Review. Ann Plast Surg 2024; 92:376-378. [PMID: 38527340 DOI: 10.1097/sap.0000000000003897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/27/2024]
Abstract
ABSTRACT Although systemic complications following liposuction are rare, visual impairment has been reported in a few cases and may occur for a variety of reasons. Here we present the case of a 31-year-old woman who underwent 360° liposuction and subsequently developed headaches and delayed partial visual disturbance 10 days after the procedure. She had symptoms suggestive of idiopathic intracranial hypertension, which was confirmed by lumbar puncture. A literature search revealed other case reports of visual changes or headaches following high-volume liposuction. Our case provides further evidence of a rare association between liposuction and idiopathic intracranial hypertension, emphasizing the need for thorough preoperative evaluations and the consideration of possible risks.
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Affiliation(s)
- Nina Mehta
- From the University of North Carolina School of Medicine, Chapel Hill, NC
| | - Usha Rajagopal
- San Francisco Plastic Surgery & Laser Center, San Francisco, CA
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Fayi KA, Ali HA, Ali NM. The Incident of Multiple Skin Necrosis and Unilateral Vision Loss Post Liposuction: A Case Report. Cureus 2023; 15:e40384. [PMID: 37456502 PMCID: PMC10344639 DOI: 10.7759/cureus.40384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/12/2023] [Indexed: 07/18/2023] Open
Abstract
For many years, people with excess weight around specific body parts who wanted to improve their shape or establish symmetry to achieve their ideal body image chose liposuction. As with any intervention, there is a chance of complications and unfavorable outcomes with liposuction. As a late result of the procedure, skin necrosis, infection, and hematoma are some of the known complications of such a procedure. Other known complications include damage to surrounding structures like nerves, vasculature, or perforating body viscera. This study aimed to report an eventful and unwanted result of a common and relatively safe cosmetic procedure. A 31-year-old Saudi female presented to the emergency room (ER) with right unilateral vision loss, bruises, and burning pain involving the upper limbs, thighs, abdomen, back, and flanks after having liposuction and rhinoplasty two weeks ago in a private clinic overseas. Multiple investigations were obtained to investigate her blindness, which showed a right upper branch of retinal vein occlusion. She was treated conservatively with daily wound dressings and analgesics. After five days, the patient returned with infected wounds and clinical deterioration, necessitating multiple excisions, debridement, and grafting. She eventually recovered and was discharged in good health. Herein, we report a rare case of unilateral blindness and multiple skin necrosis following liposuction of the abdomen and thigh. Debridement and skin grafting were the ideal treatment strategies.
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Affiliation(s)
- Khalid A Fayi
- Plastic and Reconstructive Surgery Section, Department of Surgery, King Faisal Specialist Hospital and Research Centre, Riyadh, SAU
| | - Hassan A Ali
- Department of Plastic and Reconstructive Surgery, King Abdulaziz Medical City, Riyadh, SAU
| | - Nashwa M Ali
- College of Medicine, Alfaisal University, Riyadh, SAU
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Abri Aghdam K, Aghajani A, Soltan Sanjari M, Yavari A. Anterior Ischaemic Optic Neuropathy following Liposuction in a Patient with Optic Disc Drusen. Neuroophthalmology 2020; 45:261-264. [PMID: 34366514 DOI: 10.1080/01658107.2020.1828495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Ischaemic optic neuropathy (ION) following non-ocular surgeries is a rare but devastating complication. Spine and cardiovascular surgical procedures are well known to be accompanied by this complication. ION after liposuction surgery is gaining attention during the past decades due to the escalating demand for this procedure. We report a case of unilateral anterior ION (AION) after abdominoplasty and liposuction in an eye with optic disc drusen (ODD), which has not been reported previously. The presence of ODD is not only an independent risk factor for AION in young patients, but could also be the underlying cause of the ischaemic insult to the optic nerve head in haemodynamically unstable patients.
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Affiliation(s)
- Kaveh Abri Aghdam
- Department of Ophthalmology, Eye Research Center, the Five Senses Institute, Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Ali Aghajani
- Department of Ophthalmology, Eye Research Center, the Five Senses Institute, Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Mostafa Soltan Sanjari
- Department of Ophthalmology, Eye Research Center, the Five Senses Institute, Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Azadeh Yavari
- Department of Ophthalmology, Eye Research Center, the Five Senses Institute, Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
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Abri Aghdam K, Sadeghi A, Soltan Sanjari M, Aghajani A, Gholamalizadeh S. Anterior and posterior ischemic optic neuropathy following liposuction surgery in a previously healthy young woman. Eur J Ophthalmol 2020; 32:NP240-NP245. [PMID: 33081523 DOI: 10.1177/1120672120962063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A previously healthy 28-year-old female developed bilateral painless vision loss, more prominent in the right eye than in the left, following abdominoplasty and liposuction surgery. Laboratory studies showed severe peri- and post-operative anemia. Over a 5-month follow-up, visual function remained decreased but stable in the right eye and improved in the left eye. This is the second reported case of anterior ischemic optic neuropathy in one eye and posterior ischemic optic neuropathy in the other eye after liposuction.Level of evidence: Level VI, case report study.
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Affiliation(s)
- Kaveh Abri Aghdam
- Eye Research Center, The Five Senses Institute, Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran.,Brain and Spinal Cord Injury Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Sadeghi
- Eye Research Center, The Five Senses Institute, Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Mostafa Soltan Sanjari
- Eye Research Center, The Five Senses Institute, Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Ali Aghajani
- Eye Research Center, The Five Senses Institute, Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Saba Gholamalizadeh
- Eye Research Center, The Five Senses Institute, Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
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Wang MY, Brewer R, Sadun AA. Posterior ischemic optic neuropathy: Perioperative risk factors. Taiwan J Ophthalmol 2020; 10:167-173. [PMID: 33110746 PMCID: PMC7585472 DOI: 10.4103/tjo.tjo_41_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 06/29/2020] [Indexed: 11/04/2022] Open
Abstract
Perioperative posterior ischemic optic neuropathy (PION) is a rare but devastating condition. Visual impairment is commonly bilateral, profound, and irreversible. The most frequently associated triggering events are spine surgeries, other orthopedic surgeries, cardiac bypass surgeries, and radical neck dissection. The etiology is multifactorial. The most commonly reported risk factors are severe and prolonged hypotension, anemia, hemodilution, orbital and periorbital edema, direct orbital compression by prone position, and abnormal autoregulation. This review discusses the current literature on perioperative PION and includes a study conducted by our group to investigate the perioperative risk factors of PION in order to better understand the pathogenesis and help identify high-risk patients. Our results provide further corroborating evidence that PION is associated with spinal, cardiovascular, and abdominal surgeries, longer duration of procedure, and facial edema. Anemia and chronic hypertension are frequent risk factors. Treatment for perioperative PION is uncertain and depends largely on the immediate reversal of hemodynamic alterations. Hence, it is important to identify patients at risk and accordingly take prophylactic measures to prevent its occurrence. Optimizing hemoglobin levels, hemodynamic status, and tissue oxygenation is crucial.
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Affiliation(s)
- Michelle Y Wang
- Department of Ophthalmology, Southern California Permanente Medical Group, Los Angeles, California, USA
| | - Ryan Brewer
- San Antonio Health Science Center and San Antonio Uniformed Services Health Education Consortium, University of Texas, Austin, Texas, USA
| | - Alfredo A Sadun
- Department of Ophthalmology, Doheny Eye Institute, UCLA, Pasadena, California, USA
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Quddus A, Lawlor M, Siddiqui A, Holmes P, Plant GT. Using Diffusion-Weighted Magnetic Resonance Imaging to Confirm a Diagnosis of Posterior Ischaemic Optic Neuropathy: Two Case Reports and Literature Review. Neuroophthalmology 2015; 39:161-165. [PMID: 27928349 DOI: 10.3109/01658107.2015.1021054] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2014] [Revised: 02/11/2015] [Accepted: 02/16/2015] [Indexed: 12/29/2022] Open
Abstract
Posterior ischaemic optic neuropathy is a rare cause of visual loss believed to be due to infarction in the territory of the pial branches of the ophthalmic artery. The disorder most commonly occurs in the context of prolonged surgery or giant cell arteritis, and the absence of clinical signs in the eye means that the diagnosis is one of exclusion. Here, we present two cases studies of patients who developed posterior ischaemic optic neuropathy confirmed by the observation of secondary changes on diffusion-weighted imaging sequences. In the first case visual loss followed robotic pelvic surgery, and in the second case it was associated with multiorgan dysfunction secondary to severe pancreatitis. Our cases demonstrate that in the right clinical context, diffusion-weighted imaging can provide a positive diagnosis of acute posterior ischaemic optic nerve injury in the acute phase.
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Affiliation(s)
- Ayyaz Quddus
- Royal Free London Hospital , London, United Kingdom
| | - Mitchell Lawlor
- Department of Clinical Ophthalmology, University of Sydney , Sydney, Australia , and
| | - Ata Siddiqui
- Guys and St. Thomas' Hospital , London, United Kingdom
| | - Paul Holmes
- Guys and St. Thomas' Hospital , London, United Kingdom
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Ischemic optic neuropathy as a rare but potentially devastating complication of liposuction. Plast Reconstr Surg 2011; 127:1735-1738. [PMID: 21460684 DOI: 10.1097/prs.0b013e31820a657e] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Ischemic optic neuropathy and implications for plastic surgeons: report of a new case and review of the literature. Ann Plast Surg 2011; 66:416-20. [PMID: 21389803 DOI: 10.1097/sap.0b013e3181f9b25e] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Postoperative visual loss is a rare and devastating complication after nonocular as well as ocular surgery. A case of such a complication arising as a consequence of nonocular surgery prompted a review of the literature, and an appraisal of current theories on etiology, risk factors, and potential treatment options, as well as implications for informed consent. It is clear from our review that all patients undergoing both reconstructive and cosmetic surgery are at risk. METHODS A literature review was performed to identify all cases of ischemic optic neuropathy (both anterior and posterior subtypes) subsequent to any type of plastic, reconstructive, and aesthetic surgery procedures. An analysis of current knowledge regarding risk factors, etiology, prevention, and treatment options was undertaken. RESULTS A total of 38 patients aged between 16 and 76 years affected by ischemic optic neuropathy were identified, many as a consequence of routine and sometimes minor operative procedures. CONCLUSIONS Ischemic optic neuropathy can be a devastating complication of surgery. Plastic surgeons need to be aware of the risks, as well as the signs and symptoms, and counsel at-risk patients accordingly because of the potentially devastating nature of this complication. There are significant implications in relation to informed consent, underscored by the legal case of Rogers v Whitaker, 67 ALJR 47 (Aust 1992), which highlights the importance within the consent process of complications threatening sight, no matter how small.
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Berg KT, Harrison AR, Lee MS. Perioperative visual loss in ocular and nonocular surgery. Clin Ophthalmol 2010; 4:531-46. [PMID: 20596508 PMCID: PMC2893763 DOI: 10.2147/opth.s9262] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2010] [Indexed: 01/09/2023] Open
Abstract
Incidence estimates for perioperative vision loss (POVL) after nonocular surgery range from 0.013% for all surgeries up to 0.2% following spine surgery. The most common neuro-ophthalmologic causes of POVL are the ischemic optic neuropathies (ION), either anterior (AION) or posterior (PION). We identified 111 case reports of AION following nonocular surgery in the literature, with most occurring after cardiac surgery, and 165 case reports of PION following nonocular surgery, with most occurring after spine surgery or radical neck dissection. There were an additional 526 cases of ION that did not specify if the diagnosis was AION or PION. We also identified 933 case reports of central retinal artery occlusion (CRAO), 33 cases of pituitary apoplexy, and 245 cases of cortical blindness following nonocular surgery. The incidence of POVL following ocular surgery appears to be much lower than that seen following nonocular surgery. We identified five cases in the literature of direct optic nerve trauma, 47 cases of AION, and five cases of PION following ocular surgery. The specific pathogenesis and risk factors underlying these neuro-ophthalmic complications remain unknown, and physicians should be alert to the potential for loss of vision in the postoperative period.
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Affiliation(s)
- Kathleen T Berg
- Department of Ophthalmology, University of Minnesota, Minneapolis, MN, USA
| | - Andrew R Harrison
- Department of Ophthalmology, University of Minnesota, Minneapolis, MN, USA
| | - Michael S Lee
- Department of Ophthalmology, University of Minnesota, Minneapolis, MN, USA
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