Retinal microembolism during cardiopulmonary bypass demonstrated by fluorescein angiography

Fluorescein angiography was used to study retinal microvascular perfusion in 20 patients undergoing coronary artery surgery. Colour retinal photographs and fluorescein angiograms were obtained preoperatively and at 5-14 days postoperatively. In 10 patients retinal fluorescein angiograms were also obtained intraoperatively during cardiopulmonary bypass, and all were found to have retinal microvascular occlusions after 40-160 min of extracorporeal circulation. 3 patients had in addition focal leakage of fluorescein, and 6 had foci of abnormal drainage of dye. These changes are consistent with retinal microembolism, and appeared to have resolved by the time of the postoperative study. No new pathological features appeared in the retina after surgery. Intraoperative fluorescein angiography of the retina may prove valuable for investigation of cerebrovascular microembolism in the territory of the internal carotid artery during cardiopulmonary bypass in man.