Intraocular hemorrhage associated with dental implant surgery

Hemorrhagic Complications in Implant Surgery: A Scoping Review on Etiology, Prevention, and Management

This article seeks to provide the most relevant aspects of the etiology, prevention, and management of bleeding in routine implant surgery. A comprehensive and systematic electronic search was conducted in MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, and the Cochrane Database of Systematic Reviews databases until June 2021. Further references of interest were retrieved from bibliographic lists of the selected articles and the "Related Articles" feature of PubMed. Eligibility criteria were papers about bleeding, hemorrhage, or hematoma associated with routine implant surgery on human subjects. Twenty reviews and 41 case reports fulfilled eligibility criteria and were included in the scoping review. Involved implants were mandibular in 37 and maxillary in 4 cases. The major number of bleeding complications was in the mandibular canine region. The most injured vessels were sublingual and submental arteries, due mainly to perforation of the lingual cortical plate. Time to bleeding occurred intraoperatively, at suturing, or postoperatively. The most reported clinical manifestations were swelling and elevation of the mouth floor and the tongue with partial or complete airway obstructions. First aid to manage airway obstruction was intubation and tracheostomy. For active bleeding control, gauze tamponade, manual or digital compression, hemostatic agents, and cauterization were applied. When conservative procedures failed, hemorrhage was controlled by intra- or extraoral surgical approaches to ligate injured vessels or by angiographic embolization. The present scoping review provides knowledge and evidence on the most relevant aspects of the etiology, prevention, and management of implant surgery bleeding complications.

Cleft lip and palate cause large variations in size and location of the posterior superior alveolar canal

OBJECTIVE

The aim of this study was to evaluate the posterior superior alveolar canal (PSAC) in patients with cleft lip and palate (CLP) as compared to patients with no cleft lip and palate (NC) using cone-beam computed tomography (CBCT).

MATERIALS AND METHODS

This was a retrospective multicenter study based on two steps: (1) evaluating intra- and inter-calibration and (2) detecting the presence or absence of PSAC and its location, diameter, and anastomosis with anterior superior alveolar canal.

RESULTS

A total of 300 patients were selected for the study, out of which 150 were categorized as CLP (75 men, 75 women; mean age: 29.8 years) and 150 were categorized as NC (75 men, 75 women; mean age: 40.3 years). PSAC in patients with CLP and NC was visible in 100% of the cases, in men and women, bilaterally. PSAC location in CLP was middle and upper third of the maxillary sinus as compared to NC (lower third) (chi-squared < 0.001). PSAC mean diameter in CLP was 1.12 mm. It was larger compared to 0.6 mm in NC (t-test < 0.0001).

CONCLUSION

PSAC location in patients with CLP was predominantly in the middle and upper third of the maxillary sinus, compared with NC. PSAC mean diameter in CLP was 1.12 mm. It was larger compared to that of 0.6 mm in NC.

CLINICAL RELEVANCE

These anatomical variations in CLP are important and should be acknowledged by surgeons for the following reasons: (1) to perform pre-surgical planning, (2) to avoid bleeding, and (3) to avoid neurosensory alterations.

Atypical Valsalva retinopathy from habitual ear popping

Purpose

To report a unique case of Valsalva retinopathy associated with ear popping behavior.

Observations

A 57-year-old woman with a history of well-controlled hypertension presented with episodes of seeing “spots” in her left eye for many years. Her most recent episode failed to resolve spontaneously. Fundus examination revealed scattered retinal hemorrhages in the left eye, and optical coherence tomography demonstrated sub-internal limiting membrane location of these hemorrhages. Fluorescein angiography did not reveal any vascular abnormalities. Based on these findings and an in-depth review of systems, a diagnosis of Valsalva retinopathy was made associated with patient's ear popping habit.

Conclusions and importance

Habitual ear popping can be a potential etiology of symptomatic Valsalva retinopathy. This under-appreciated association may be clinically relevant for patients with a history of suspected Eustachian tube narrowing or dysfunction.

An eye for a tooth

OBJECTIVE

To propose a possible link between dental extraction and intra-ocular complications.

BACKGROUND

Several publications in medical literature describe intra-ocular complications after different dental procedures.

RESULTS

Retinal detachment and vitreous hemorrhage following dental extraction with an appropriate anesthesia.

CONCLUSION

Systemic complications following dental treatments should not be neglected and proper medical treatment must be provided as soon as possible.

Maculopathy: a rare association of the Valsalva manoeuvre (Valsalva maculopathy)

A 22-year-old man complained of sudden, painless loss of vision (vague scotoma in central vision) in his right eye. The patient became symptomatic following a session of weight training at a gymnasium the previous day. There was no history trauma. Medical, ocular and familial history were unremarkable. The inferior and temporal aspect of the haemorrhage was darker due to gravitation, but the rest of the fundus was normal. The appearance of the right fundus, combined with an associated unequivocal history of physical exertion, was consistent with a diagnosis of Valsalva maculopathy (holding breath while bench pressing). Systemic examination and all relevant blood tests were normal. Fluorescein angiography (FFA) was done which confirmed the diagnosis. The patient recovered a vision of 6/6 in his right eye after 2 months. FFA was again done, which showed no sequelae of the problem.

Valsalva retinopathy associated with an oratorical contest

A 17-year-old man presented to us with a chief complaint of decreased visual acuity accompanied by central scotoma. There was nothing unusual in his medical history other than a recent oratorical contest. At the time of initial diagnosis, the corrected visual acuity was 20/20 in the right eye and 20/100 in the left eye. No significant findings were apparent on ophthalmic evaluation. On fundoscopy, there was a dumbbell-shaped macular bleed with a well-defined margin in the left eye. The clinical course was closely monitored along with drug therapy. Four weeks post presentation, the pre-retinal hemorrhage had nearly resolved. On fluorescein angiography, no significant findings were observed. In the left eye, the corrected visual acuity had improved to 20/25. Valsalva retinopathy is a pathology that occurs when a sudden increase in intra-thoracic pressure or abdominal pressure occurs in an otherwise healthy person. Here we report a case of Valsalva retinopathy occurring following an oratorical contest along with a review of the relevant literature.

Outcomes of Nd:YAG laser treatment for Valsalva retinopathy due to intense military exercise

BACKGROUND AND OBJECTIVE

Valsalva retinopathy may occur due to intense physical exercise. Soldiers must undergo vigorous physical training to sustain a high level of readiness. The aim of this study was to evaluate the recovery period and the outcomes of Valsalva retinopathy due to physical exercise in the Turkish Army.

PATIENTS AND METHODS

Twelve soldiers had Valsalva retinopathy related to military exercise. All patients received Nd:YAG laser membranotomy and were observed for an average of 12.6 months.

RESULTS

All eyes had visual acuities of 20/20 at the end of the first month of follow-up. Therefore, the soldiers could continue their training. No complications were observed and additional surgeries were not needed during the 1-year follow-up.

CONCLUSIONS

Early visual recovery is important to continue training and reduce health costs in the Turkish Army, where military service is mandatory for a required period of time. For that reason, Nd:YAG laser treatment for Valsalva retinopathy related to military exercise is an effective and safe procedure.

Valsalva retinopathy associated with vigorous dancing in a discotheque

Valsalva retinopathy develops in response to a Valsalva maneuver. Decreased visual acuity may be caused by preretinal hemorrhage, which is related to the fovea, or by vitreous hemorrhage. The hemorrhage usually clears spontaneously. A case of Valsalva maculopathy in a young, healthy boy caused by physical exertion while dancing at a club is described. Reduced visual acuity and premacular hemorrhage spontaneously resolved during the 5-month postoperative period.

Valsalva retinopathy associated with fiberoptic gastroenteroscopy

CASE REPORT

A 45-year-old woman presented with a sudden loss of vision in her left eye, which occurred while she was having a routine upper fiberoptic gastroenteroscopy. According to the gastrointestinal specialist, the patient had performed multiple sustained Valsalva maneuvers during the procedure. Funduscopy showed a preretinal hemorrhage with a half disc diameter in the fovea of the left eye.

COMMENTS

A diagnosis of Valsalva retinopathy was made on the basis of history and fundus finding. The hemorrhage resolved within 2 months without any sequelae. To our knowledge, this is the first report of the occurrence of Valsalva retinopathy following a routine upper fiberoptic gastroenteroscopy.

Long-term results of Nd:YAG laser treatment for premacular subhyaloid haemorrhage owing to Valsalva retinopathy

AIMS

Valsalva retinopathy produces sudden visual loss, which may be prolonged if untreated. Nd:YAG laser enables rapid diffusion of premacular subhyaloid haemorrhage. This study was performed to assess the long-term results and safety of Nd:YAG laser treatment in cases with Valsalva retinopathy.

METHODS

Sixteen patients had Nd:YAG laser treatment to drain premacular haemorrhage. The follow-up period was 24 months.

RESULTS

All eyes had marked clearing of haemorrhage and immediate improvement of vision following laser treatment. In 14 eyes visual acuity improved to 20/20 level at the end of the first week and the remaining two patients achieved 20/20 level within 1 month. No patient had evidence of retinal or choroidal damage.

CONCLUSION

Nd:YAG laser treatment for Valsalva retinopathy is an effective, non-invasive, and safe procedure for patients with a premacular subhyaloid haemorrhage larger than 3 disc diameter and no longer than 3 weeks of duration.

Vitreous haemorrhage in elderly patients: management and prevention

Vitreous haemorrhage can be caused by a disruption of normal retinal vessels, bleeding from diseased retinal vessels, bleeding from abnormal new vessels or extension of haemorrhage through the retina from other sources. In the elderly, vitreous haemorrhage usually occurs spontaneously and only occurs occasionally as a result of trauma. Appropriate management of vitreous haemorrhage is dependent on the most likely cause in a particular patient. As always, an accurate medical history with a careful clinical examination, static and dynamic ultrasonography performed by an experienced examiner, results of other laboratory tests and an understanding of the common causes of vitreous haemorrhage in each age group is essential to come to a 'best guess' diagnosis as to the cause of the vitreous haemorrhage and thus guide the physician toward the appropriate management. Immediate surgical removal of blood if indicated, as well as improving the vision gives the added benefit of allowing a full examination of the underlying retina. For those in whom surgical removal of blood is not recommended, a careful and frequent follow-up with serial B-scan ultrasound allows the 'best guess' diagnosis to be confirmed at each visit, until such time as the vitreous haemorrhage resolves sufficiently to allow a full and proper examination of the retina. Where there is a confirmed retinal tear, retinal detachment or other fundal pathology these are treated appropriately with laser or surgery (vitrectomy). Preventative measures are dependent on the underlying cause of vitreous haemorrhage. Some of the underlying causes such as posterior vitreous detachment cannot be prevented. In others, such as retinal vein occlusion, measures may need to be taken so as to reduce the risk of a similar event in the same or fellow eye and to reduce the risk of potentially life-threatening associated systemic conditions such as a stroke or myocardial infarction.

Clinical complications with implants and implant prostheses

The purpose of this article is to identify the types of complications that have been reported in conjunction with endosseous root form implants and associated implant prostheses. A Medline and an extensive hand search were performed on English-language publications beginning in 1981. The searches focused on publications that contained clinical data regarding success/failure/complications. The complications were divided into the following 6 categories: surgical, implant loss, bone loss, peri-implant soft tissue, mechanical, and esthetic/phonetic. The raw data were combined from multiple studies and means calculated to identify trends noted in the incidences of complications. The most common implant complications (those with a greater than a 15% incidence) were loosening of the overdenture retentive mechanism (33%), implant loss in irradiated maxillae (25%), hemorrhage-related complications (24%), resin veneer fracture with fixed partial dentures (22%), implant loss with maxillary overdentures (21%), overdentures needing to be relined (19%), implant loss in type IV bone (16%), and overdenture clip/attachment fracture (16%). It was not possible to calculate an overall complications incidence for implant prostheses because there were not multiple clinical studies that simultaneously evaluated all or most of the categories of complications. Although the implant data had to be obtained from different studies, they do indicate a trend toward a greater incidence of complications with implant prostheses than single crowns, fixed partial dentures, all-ceramic crowns, resin-bonded prostheses, and posts and cores.

Valsalva maculopathy

The Valsalva manoeuvre comprises forcible exhalation against the closed glottis, thereby creating a sudden increase in the intrathoracic or intra-abdominal pressure. A simultaneous rapid rise in intraocular venous pressure may result in the spontaneous rupture of perifoveal capillaries, leading to a characteristic clinical picture of a preretinal haemorrhage in an otherwise healthy eye. The haemorrhage typically occurs at the macula and in the vast majority of cases resolves without compromising visual acuity. Valsalva maculopathy is an isolated and self-limited event. A case of Valsalva maculopathy in a young healthy male attributable to an incontrovertible Valsalva stress associated with weightlifting is presented.

Premacular Subhyaloid Hemorrhage Following Laser in situ Keratomileusis

PURPOSE

To report a case of premacular subhyaloid hemorrhage following laser in situ keratomileusis (LASIK).

METHODS

Case report.

RESULTS

The subhyaloid hemorrhage did not resolve over 1 month of observation, necessitating Nd:YAG posterior hyaloidotomy.

CONCLUSION

The LASIK procedure can be associated with postoperative subhyaloid hemorrhage, presumably from rapid release of the microkeratome vacuum pressure.