Retinal Hemorrhage after Epiduroscopy in a Patient using Dexamethasone: A Case Report

Epiduroscopy is a minimally invasive procedureused to diagnose epidural fibrosis and torelease this fibrosis; epiduroscopy is also usedto precisely deposit medication into the epiduralspace. It is commonly used in patients who arediagnosed with failed back surgery syndrome(FBSS) after more conservative treatment hasfailed to provide sufficient relief of symptoms.A rare complication of epiduroscopy is retinalhemorrhaging, which is likely caused by overpressurizationof the epidural space during theprocedure. Patient-related risk factors for developingretinal hemorrhage after epiduroscopyremain largely unknown. This is the first casereport of retinal hemorrhage in a patient usingchronic dexamethasone.We describe a 73-year-old man diagnosed withFBSS who underwent epiduroscopy to diagnoseand relieve epidural fibrosis. The procedure wasuneventful and he was discharged from our clinicthe same day, but upon routine check-up he mentionedblurry vision. Immediately he was referredto an ophthalmologist who diagnosed retinalhemorrhages in both eyes upon fundoscopic examination.Our patient was using dexamethasonefor the treatment of allergies. Three months afterthe procedure, his vision was restored fully in theright eye and 95% in the left eye.Chronic corticosteroid use may weaken retinalveins, making them prone to rupture when thereis increased pressure, even for a short periodof time. Chronic use of corticosteroids must beconsidered a risk factor for developing retinal hemorrhagesin patients undergoing epiduroscopy.Long-term use of corticosteroid can be consideredas a relative contraindication for epiduroscopy.Key words: Epiduroscopy, complications, interventionalpain, corticosteroids, retinal hemmorhage,failed back surgery syndrome