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

Madhuri Meshram; Amit S Nene; Pushpanjali Ramteke; Pratik Shenoy; Hitesh Rawlani; Smitesh Shah

doi:10.4103/ijo.IJO_1876_22

CASE REPORT

Year : 2023 | Volume : 3 | Issue : 1 | Page : 103-105

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

Madhuri Meshram¹, Amit S Nene¹, Pushpanjali Ramteke¹, Pratik Shenoy¹, Hitesh Rawlani², Smitesh Shah¹
¹ Department of Ophthalmology, Isha Netralaya, Kalyan, Maharashtra, India
² Department of Optometry, Isha Netralaya, Kalyan, Maharashtra, India

Date of Submission	31-Jul-2022
Date of Acceptance	29-Sep-2022
Date of Web Publication	20-Jan-2023

Correspondence Address:
Amit S Nene
Isha Netralaya, Radhakrishna Sankul, Opp Holy Cross Hospital, Karnik Road, Kalyan - 421 301, Maharashtra
India

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ijo.IJO_1876_22

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

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

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

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.

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