Outer retinal ischemic infarction--a newly recognized complication of cataract extraction and closed vitrectomy. Part...

This report describes a peculiar syndrome occurring as a complication of cataract extraction. The syndrome is characterized initially by (1) acute loss of central and paracentral vision discovered usually on the first postoperative day; (2) diffuse and patchy whitening of the outer retinal layers in the posterior fundus; (3) normal angiographic retinal and choroidal appearance and circulation time; (4) a peculiar polygonal pattern of fluorescein staining of the pigment epithelium and outer retina in the area of retinal whitening, and followed later by (5) clearing of the retinal whitening and mottled changes in the pigment epithelium; (6) partial recovery of the central visual field; and (7) preservation of normal optic disc and retinal vessel caliber. Prolonged elevation of the intraocular pressure sufficient to obstruct choroidal blood flow occurring during the use of intraocular volume-reducing devices before surgery, during phakoemulsification or closed vitrectomy is postulated as the major cause of this complication.