Posters

Foveal ischemia following phacoemulsification under peribulbar anaesthesia

Poster Details

First Author: I.Placinta SPAIN

Co Author(s):    C. Martinez-Rubio   R. Molina-Pallete   P. Martinez Lopez-Corell   R. Garcia-Gil   P. Udaondo-Mirete        

Abstract Details

Purpose:

To present the case of a 78 years old man presenting with hand motion visual acuity in his left eye following phacoemulsification under peribulbar anesthesia.

Setting:

University and Polytechnic Hospital la Fe, Valencia, Spain

Methods:

A complete ophthalmological exploration was performed: visual acuity, anterior pole slit lamp examination, posterior pole fundoscopy, retinography, multicolour retinography, autofluorescence retinography, macular B-scan optical coherence tomography (OCT), blood test with haemogram, coagulation, C reactive protein, erythrocyte sedimentation rate, fibrinogen, supra aortic trunks Doppler sonography, and echocardiogram.

Results:

Cherry red spot macula was observed on the left eye retinography. Macular OCT B-scan revealed perifoveal oedema at the innermost layers of the retina with a central macular thickness of 335 microns. Central retinal artery sonography showed a peak systolic strain rate of 45 cm/s in the right eye and 30 cm/s in the left eye. Treatment was initiated with oral corticosteroids intravitreal anti VEGF and dexamethasone implant. Macular oedema progressed to macular atrophy. There was no improvement of visual acuity.

Conclusions:

The cause of foveal ischemia could not be determined. We believe that a temporary reduction of the blood flow in the central retinal artery due to a temporary increase in the orbital pressure secondary to the peribulbar anesthesia in a predisposed patient may have played a role. Paracentral acute middle maculopathy (PAMM) disease spectrum may also be considered into the differentials.

Financial Disclosure:

None