Central retinal-artery occlusion in proliferative sickle-cell retinopathy after retrobulbar injection

Central retinal-artery obstruction (CRAO) is a devastating complication after retrobulbar anesthesia, a procedure which was previously recommended routinely to immobilize the eye and reduce discomfort during laser surgery. Recent developments in treatment technique, involving scatter laser applications given over several sessions with smaller spot sizes and shorter durations, have virtually eliminated the need for retrobulbar injections and the risks of retrobulbar hemorrhage, which can cause increased intraocular pressure and culminate in closure of the arterial circulation. We present the case of a patient with proliferative sickle retinopathy who sustained such a complication after direct photocoagulation treatment of sea-fans elsewhere and offer alternative treatment techniques which we have used for the past ten years that eliminate this hazard.