Vascular Occlusions following Ocular Surgical Procedures: A Clinical Observation of Vascular Complications after Ocular Surgery

Abstract

Background Ocular vascular occlusions following intraocular procedures are a rare complication. We report a case series of patients with retinal vascular occlusions or anterior ischemic optic neuropathy (AION) after anterior and posterior segment surgery and demonstrate possible risk factors. Methods Observational case series. Results In ten patients, vascular occlusions were observed within ten weeks after intraocular surgery: branch retinal arterial occlusion (BRAO) (n = 2), central retinal artery occlusion (CRAO) (n = 2), central retinal vein occlusion (CRVO) (n = 1), branch retinal vein occlusion (BRVO) (n = 1), anterior ischemic optic neuropathy (AION) (n = 3), and combined central artery and vein occlusion (n = 1). AION occurred later (27–69 d) than arterial occlusions (14–60 d) or venous occlusions (1-2 d). In all cases, either specific surgical manipulations or general vascular disorders were identified as risk factors. In addition to general cardiovascular risk factors (arterial hypertension n = 6, diabetes mellitus n = 4), internal workup disclosed bilateral stenosis of the carotid arteries (n = 1) and myeloproliferative syndrome (n = 1). Conclusion Vascular occlusions after surgical ocular procedures seem to be more frequent when cardiovascular diseases coexist. Surgical maneuvers and intra- or postoperative pressure changes may act as a triggering mechanism in patients with underlying systemic cardiovascular disorders. Affected patients should undergo thorough internal examination to identify possible underlying diseases.

Suspected Gentamicin-Induced Retinal Vascular Occlusion after Vitrectomy

“…Other than drug toxicity, postoperative vascular occlusion is caused by post-bulbar anesthesia, gas injection, or increased IOP during and after surgery [1][2][3]. In our case, no obvious IOP abnormality was observed during or after surgery, and no problems such as retrobulbar hemorrhage occurred during retrobulbar anesthesia.…”

“…A history of cardiovascular disease, retrobulbar anesthesia injection, high intraocular pressure (IOP) during the perioperative period, and drug toxicity have been reported as the possible causative factors of the rare and serious complication of retinal vascular occlusion after intraocular surgery [1][2][3].…”

Central retinal artery occlusion on postoperative day one after vitreoretinal surgery

“…CRAO after PPV with scleral buckling has been reported, 7 but the first case occurred 19 days after surgery in a patient with known bilateral severe carotid artery stenosis, and the second case occurred 21 days after surgery and was a combined CRAO-central retinal vein occlusion. In addition, one branch retinal artery occlusion (BRAO) occurred 23 days after PPV with scleral buckling, and another case of BRAO 14 days after PPV 7 ; both occurred in patients with known vascular risk factors. Malinowski and Pesin 13 have also reported BRAO 12 days after PPV.…”

Central retinal artery occlusion following orbital biopsy

“…Though previously attributed to retro‐ or peribulbar anaesthesia, a recent observational series reported vascular occlusions without the use of either type of regional block, suggesting other factors may have a role . The effects of peribulbar anaesthesia on ocular blood flow have been well documented, with a prospective study demonstrating a decrease in mean blood flow velocity by 15% at 5 min following injection, despite IOP normalizing by this point, supporting the theory of drug‐induced vasoconstriction as a cause of compromised blood flow perioperatively .…”

“…Whilst a rare complication, CRAO has been previously reported following uneventful ocular surgery with only a few reports following orbital surgery . In a similar case describing CRAO following orbital tumour resection via an inferior transconjunctival approach, surgical manipulation of the globe was referenced as a key factor .…”