J Korean Ophthalmol Soc.  2008 Jun;49(6):1013-1017. 10.3341/jkos.2008.49.6.1013.

Combined Central Retinal Vein and Artery Occlusion After Retrobulbar Anesthesia: A Case Report

• Lim HW
• Ko BW
• Song Y
• Park YS
• Lee BR

• KMID: 2110885
• DOI: http://doi.org/10.3341/jkos.2008.49.6.1013

Abstract

PURPOSE: To report central retinal vein and artery occlusion after retrobulbar anesthesia for a cataract operation.
CASE SUMMARY
A 65-year-old woman was transferred to our facility 4 days after she had undergone cataract extraction with IOL implantation. She could count fingers and had a relative afferent papillary defect in her left eye. As seen upon fundus examination, dot-shaped, circular-shaped irregular, and partially linear-shaped retinal hemorrhages were evident. Fluorescein angiography revealed that branch arteries around the nasal and temporal areas were not filled, and that the filling of veins was delayed. After two weeks, the patient was only able to recognize hand motion, and her intraocular pressure was 10 mmHg. According to a fundus examination, the size and quantity of retinal hemorrhages increased, and a pale, macular edema was observed. Following fluorescein angiography, the filling defect of branch vessels on the nasal and temporal areas was still evident, and the blocked fluorescence of capillaries on the fundus was prominent. After two months, she could still only recognize hand motion, and her intraocular pressure had increased to 35 mmHg; we therefore diagnosed a neovascular glaucoma.
CONCLUSIONS
A patient experienced a serious central retinal vessel occlusion after retrobulbar anesthesia for cataract extraction. Retrobulbar injections should therefore be administered with great caution to prevent this outcome.

Keyword

Combined Central Retinal Vein and Artery Occlusion; Retrobulbar anesthesia

MeSH Terms

Aged
Anesthesia
Arteries
Capillaries
Cataract
Cataract Extraction
Eye
Female
Fingers
Fluorescein Angiography
Fluorescence
Glaucoma, Neovascular
Glycosaminoglycans
Hand
Humans
Intraocular Pressure
Macular Edema
Retinal Hemorrhage
Retinal Vein
Retinal Vessels
Veins
Glycosaminoglycans

Figure

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  Figure 1. Fundus photography and fluorescein angiography were performed 4 days after the cataract operation; (A) Fundus photograph reveals retinal whitening, large dot blot hemorrhages, macular edema, and cherry red spot; (B, C, D) Fluorescein angiographs reveal markedly delayed filling of the retinal artery and vein (B, early phase), multiple second‐ order arteriolar occlusion, extensive retinal nonperfusion, dense hypofluorescent dots related to retinal hemorrhage and late staining of the optic disc. (C, mid phase; D, late phase)

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  Figure 2. T1-weighted axial spin-echo nuclear MRI was performed 4 days after the cataract operation. It doesn’t show asymmetry of the optic nerve sheaths.

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  Figure 3. Fundus photography and fluorescein angiography were performed 18 days after the cataract operation; (A) Fundus photographs reveal persistent retinal whitening, increased preretinal hemorrhages and macular edema; (B, C, D) Fluorescein angiographs reveal increased extensive retinal nonperfusion and increased dense hypofluorescent dots related to retinal hemorrhage.

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  Figure 4. The anterior angle of the left eye on postoperative 11 weeks. Note the neovascularization of the angle.

Reference

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