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Central retinal artery occlusion after phacoemulsification.

Brighu N Swamy1, Rohan Merani, Alex Hunyor

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Central retinal artery occlusion (CRAO) is a rare complication following routine cataract surgery. This report details two cases and explores potential mechanisms, favoring a mechanical effect from anesthesia.

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Area of Science:

  • Ophthalmology
  • Surgical Complications
  • Vascular Occlusive Diseases

Background:

  • Cataract surgery is a common procedure with a low risk of serious complications.
  • Central retinal artery occlusion (CRAO) is a vision-threatening event typically associated with systemic vascular disease.

Purpose of the Study:

  • To document two instances of CRAO occurring shortly after phacoemulsification cataract surgery under peribulbar anesthesia.
  • To investigate potential etiological factors for CRAO in the context of routine intraocular surgery.

Main Methods:

  • Presentation of two distinct patient cases with CRAO post-cataract surgery.
  • Review of existing literature on CRAO following intraocular procedures.
  • Formulation of hypotheses regarding the underlying mechanisms.

Main Results:

  • Both patients experienced severe vision loss (counting fingers) due to CRAO on the first postoperative day.
  • Standard emergency interventions did not restore visual acuity.

Conclusions:

  • CRAO is an uncommon but severe complication of cataract surgery.
  • Plausible mechanisms include anesthetic-induced vasoconstriction, increased intraocular pressure, or mechanical compression of the central retinal artery.
  • A mechanical effect from the anesthetic volume is proposed as the most likely cause.