Central retinal artery occlusion after phacoemulsification

To report 2 cases of central retinal artery occlusion (CRAO) that occurred within 24 hours of routine phacoemulsification cataract surgery using peribulbar anesthesia.

Case 1: An otherwise well 76-year-old woman with right pseudoexfoliation syndrome and bilateral open angle glaucoma presented with right visual acuity of counting fingers on the first postoperative day after cataract surgery. The CRAO was noted on fundoscopy. Emergency measures to reduce intraocular pressure (IOP) and hyperbaric oxygen treatment were performed. Case 2: A 59-year-old man with a history of non-Hodgkin's lymphoma, hypertension, hyperlipidemia, and ischemic stroke was similarly diagnosed with CRAO on the first postoperative day, with left visual acuity of counting fingers.

The final visual acuity remained at counting fingers in both cases.

Central retinal artery occlusion after routine cataract surgery is unusual. We review the literature on CRAO after routine intraocular procedures and propose three hypotheses regarding the potential mechanisms involved. A vasoconstrictive effect of the anesthetic agent on the central retinal artery, a rise in lOPs after anesthesia administration resulting in closure of the central retinal artery, and a mechanical effect of the volume of anesthetic on the central retinal artery are considered as plausible mechanisms, with a mechanical effect being the favored hypothesis.