Central Retinal Arterial Occlusion (CRAO) after Phacoemulsification-A Rare Complication

Abstract

Background: While peribulbar anesthesia is generally safe, a remote risk of retinal vascular accident exists and its routine use should be done with caution. Objective: To report a case of central retinal artery occlusion (CRAO) that occurred within 24 hours of routine uneventful phacoemulsification cataract surgery using peribulbar anesthesia. We share our experience of a 45-year old man who underwent uneventful clear corneal temporal incision phacoemulsification cataract surgery using peribulbar lignocain injection with adrenaline. Case: A Patient who underwent routine phacoemulsification surgery of left eye for posterior sub-capsular cataract under peribulbar anesthesia developed central retinal artery occlusion in the immediate post-operative period. The surgery was uneventful. Conclusion: Central retinal artery occlusion is a rare but dreadful complication seen after uneventful phacoemulsification and the cause is mainly due to anesthesia related.

Profound vascular stasis of retina and optic nerve following retrobulbar anesthesia

“…The ischemic events described in this study were noted in different hospitals with different surgeons administering the block, suggesting that this is not related to technique or idiosyncrasies in block composition. There have been reports of epinephrine-associated vasoconstriction resulting in similar findings, 6 , 7 but none of the block components in our series contained epinephrine. In a study of postvitrectomy optic neuropathy, 71% of patients experienced intraoperative hypotension, which was hypothesized to result in a drop in intraocular perfusion pressure; 8 in our cases, no intraoperative drop in systemic blood pressure was documented.…”

Central retinal artery occlusion on postoperative day one after vitreoretinal surgery

“…CRAO is a known but very rare complication of ocular surgery that can occur after retrobulbar, peribulbar, or sub-Tenon's anesthesia. 1 , 3 , 4 , 5 , 6 , 8 , 9 , 10 , 11 , 12 , 14 , 17 , 18 , 19 , 20 , 21 Calenda et al 4 reported CRAO after peribulbar anesthesia for PPV for RRD repair, and Jung et al 10 reported two cases of CRAO after PPV using retrobulbar anesthesia. Ascaso 1 reported transient CRAO after peribulbar anesthesia for PPV.…”

“…Central retinal artery occlusion (CRAO) is known to be a rare complication associated with ocular surgery. 11 Retrobulbar anesthetic injections are a known association, 3 , 8 , 10 , 14 , 18 , 19 , 20 though there are also reports of CRAO occurring after peribulbar 1 , 4 , 9 , 12 , 17 , 21 and sub-Tenon's 5 , 6 injections. Visual recovery is generally poor in these patients.…”

Iatrogenic central retinal artery occlusion following retrobulbar anesthesia with adrenaline for vitreoretinal surgery: a case report

“…Central retinal artery occlusion (CRAO) has been reported as a rare complication associated to intraocular surgery in different types of ophthalmic surgery [1][2][3][4]. CRAO associated to anesthesia administration has been reported after sub-tenon [5,6], peribulbar [7][8][9][10][11] and especially retrobulbar injection [2,[12][13][14][15][16]. Visual recovery is consistently reported to be poor in these patients.…”