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 Table of Contents  
CASE REPORT
Year : 2023  |  Volume : 3  |  Issue : 1  |  Page : 103-105

Branch retinal artery occlusion post-vitreo-retinal surgery – A case report


1 Department of Ophthalmology, Isha Netralaya, Kalyan, Maharashtra, India
2 Department of Optometry, Isha Netralaya, Kalyan, Maharashtra, India

Date of Submission31-Jul-2022
Date of Acceptance29-Sep-2022
Date of Web Publication20-Jan-2023

Correspondence Address:
Amit S Nene
Isha Netralaya, Radhakrishna Sankul, Opp Holy Cross Hospital, Karnik Road, Kalyan - 421 301, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijo.IJO_1876_22

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  Abstract 


We report a case of 50 year old female patient who underwent vitreo-retina surgery in left eye for retinal detachment and presented with branch retinal artery occlusion (BRAO) one month post surgery. Surgical procedures included scleral buckling, pars plana vitrectomy and silicon oil injection. Her best corrected visual acuity (BCVA) was 1/60 and intraocular pressure was 46 mm of Hg. Partial SOR was done which resulted in reperfusion and improvement in visual acuity. Early intervention is the key in managing such complications.

Keywords: Vitreo-retinal surgery, retinal detachment, BRAO, intraocular pressure, silicon oil


How to cite this article:
Meshram M, Nene AS, Ramteke P, Shenoy P, Rawlani H, Shah S. Branch retinal artery occlusion post-vitreo-retinal surgery – A case report. Indian J Ophthalmol Case Rep 2023;3:103-5

How to cite this URL:
Meshram M, Nene AS, Ramteke P, Shenoy P, Rawlani H, Shah S. Branch retinal artery occlusion post-vitreo-retinal surgery – A case report. Indian J Ophthalmol Case Rep [serial online] 2023 [cited 2023 Feb 1];3:103-5. Available from: https://www.ijoreports.in/text.asp?2023/3/1/103/368187



Branch retinal artery occlusion (BRAO) results in irreversible vision and visual field loss.[1] The incidence of central retinal artery occlusion (CRAO) and BRAO has been reported to be 1.64 and 4.99 per 100,000, respectively.[2] BRAO is a rare but serious adverse event after retinal surgery. CRAO post-retinal surgeries have been reported previously.[3] However, there are limited reports about BRAO post-retinal surgery. Here, we report a case of BRAO following silicon oil tamponade and scleral buckling operated for fresh rhegmatogenous retinal detachment.


  Case Report Top


A 50-year-old female patient came to us with the complaint of sudden painless diminution of vision in the left eye with the best corrected visual acuity (BCVA) of HM +, following which a diagnosis of fresh rhegmatogenous retinal detachment was made and urgent surgery was advised. Systemic work-up including electrocardiograms, 2D Echo, complete blood count, and lipid profiles was performed prior to the surgery and found to be normal. Operative procedures included peribulbar anesthetic block with lidocaine (2%) and bupivacaine (0.5%), scleral buckling, pars plana vitrectomy, and silicon oil injection. Post-operatively, the patient maintained a prone position for 1 week. On post-operative day 5, her visual acuity was 3/60 and fundus examination was normal [Figure 1]. On 1 month follow-up, she complained of pain in the left eye with diminution of vision, which was noted to be 1/60. There was pupillary block with a shallow anterior chamber, and the intra-ocular pressure (IOP) was 46 mm of Hg. Fundus examination showed an attached retina under oil with a whitening temporal to disc sparing fovea, suggestive of branch retinal artery occlusion [Figure 2]a. Optical coherence tomography (OCT) showed hyper-reflectivity and thickening of the inner retinal layer in the corresponding area of retinal whitening. The patient was managed with topical and oral anti-glaucoma medication and underwent laser iridotomy. However, in the view of non-resolving pupillary block, partial silicon oil removal (SOR) with surgical iridectomy was performed. At 2 weeks follow-up after partial SOR, there was gradual improvement in visual acuity [Figure 2]b and reduction in IOP. Her BCVA was 6/24. After 2 months, complete SOR was performed, following which the retina was attached [Figure 3] and the patient regained a BCVA of 6/18 with reperfused BRAO.
Figure 1: Fundus photo and optical coherence tomography (OCT) post-retinal detachment surgery

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Figure 2: (a) BRAO in the oil-filled eye; (b) BRAO after partial SOR

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Figure 3: Fundus photos and OCT post 2 months of complete SOR showing an attached retina with reperfused BRAO

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  Discussion Top


Currently, there are no evidence-based effective treatments for BRAO.[4] Studies have shown that retinal artery occlusions lasting more than 240 minutes can lead to irreversible retinal damage.[1] BRAO because of a rise in IOP following gas endotamponade has been reported previously.[5],[6] BRAO is the most significant complication and occurs via different pathophysiologic mechanisms.[7],[8] Retinal surgeries are usually performed under local anethesia. The mechanical effect of bolus anesthesia may raise IOP, and presumed toxic effects from preservatives contained in the anesthesia vial can lead to BRAO. Second, scleral buckling can lead to a decrease in ocular blood flow. Also, a sudden increase in IOP in silicon oil-filled eyes has been noted previously. Silicone oil overfill and pupillary block could be the probable cause of raised IOP. Reperfusion after partial SOR and surgical iridectomy confirmed that the BRAO was because of raised IOP and not because of silicone oil-induced whitening.


  Conclusion Top


Our report suggests close monitoring of IOPs in early and late post-operative periods in patients with silicon oil tamponade.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Hayreh SS, Podhajsky PA, Zimmerman MB. Branch retinal artery occlusion. Natural history of visual outcome. Ophthalmology 2009;116:1-23.  Back to cited text no. 1
    
2.
Chang YS, Jan RL, Weng SF, Wang JJ, Chio CC, Wei FT, et al. Retinal artery occlusion and the 3-year risk of stroke in Taiwan: A nationwide population-based study. Am J Ophthalmol 2012;154:645-52.e1.  Back to cited text no. 2
    
3.
Russell JF, Scott NL, Haddock LJ, Eaton AM, Flynn HW. Central retinal artery occlusion on postoperative day one after vitreoretinal surgery. Am J Ophthalmol Case Rep 2018;12:93-6.  Back to cited text no. 3
    
4.
Dattilo M, Newman NJ, Biousse V. Acute retinal arterial ischemia. Ann Eye Sci 2018;3:28.  Back to cited text no. 4
    
5.
Chen PP, Thompson JT. Risk factors for elevated intraocular pressure after the use of intraocular gases in vitreoretinal surgery. Ophthalmic Surg Lasers 1997;28:37-42.  Back to cited text no. 5
    
6.
Müller M, Geerling G, Zierhut M, Klink T. Glaucoma and retinal surgery. Ophthalmologe 2010;107:419-26.  Back to cited text no. 6
    
7.
Fischer C, Bruggemann A, Hager A, Callizo Planas J, Roider J, Hoerauf H. Vascular occlusions following ocular surgical procedures: A clinical observation of vascular complications after ocular surgery. J Ophthalmol 2017;2017:9120892.  Back to cited text no. 7
    
8.
Ogasawara H, Feke GT, Yoshida A, Milbocker MT, Weiter JJ, McMeel JW. Retinal blood flow alterations associated with scleral buckling and encircling procedures. Br J Ophthalmol 1992;76:275-9.  Back to cited text no. 8
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

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