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PURPOSE: To report a case of branch retinal artery wall rupture and subsequent branch retinal artery occlusion occurring during a routine pars plana vitrectomy with epiretinal membrane and internal limiting membrane peeling. METHODS: Case report. Multimodal imaging including fluorescein angiography, spectral domain optical coherence tomography (OCT), en face OCT, and OCT angiography were performed. RESULTS: An 86-year-old woman presented with a symptomatic epiretinal membrane in the right eye. Pars plana vitrectomy with epiretinal membrane and internal limiting membrane peel was performed. During the peel, spontaneous preretinal and intraretinal hemorrhage emanating from an adjacent branch retinal artery developed. At postoperative Week 1, OCT showed retinal thinning and hyperreflectivity suggestive of vascular accident. At postoperative Year 1, OCT imaging revealed retinal atrophy while fluorescein angiography demonstrated the arterial occlusion, and OCT angiography illustrated reduction in retinal perfusion in the region of the branch retinal artery occlusion. CONCLUSION: The authors report an unusual case of retinal arterial wall rupture and hemorrhaging during routine pars plana vitrectomy with membrane peel resulting in a branch retinal artery occlusion and subsequent retinal atrophy. Surgeons must limit stress on the underlying retina during membrane peel to avoid this surgical complication.

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We report the trans-operative approach and short-term outcome of a patient who suffered a traumatic avulsion of the cilioretinal artery branch during the surgical management of a cilioretinal arterial branch occlusion (CRABO) with intraocular embolectomy. A patient with acute CRABO underwent a pars plana vitrectomy with in situ embolectomy. The blocked artery was incised using 25 gauge vertical scissors, and embolus manipulation was done using microsurgical forceps. During embolus extraction, the occluded cilioretinal artery and its branch were inadvertently avulsed and torn with subsequent intense bleeding. Laser and endodiathermy were used for acute hemostasis. The maneuvers created an unintended retinochoroidal anastomosis. Visual field improvement was noted 3 months after the surgery. In the event of a complicated surgical embolectomy with the avulsion of the artery, the formation of a retinochoroidal anastomosis and reperfusion of the occluded may occur along with the improvement of visual fields in some cases.

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Intraocular foreign body (IOFB) in cases of penetrating eye injury accounts for an important indication of vitreoretinal intervention following ocular trauma. Vascular occlusion as a complication of IOFB is rare. Here we present a case of a 34-year-old male with post-traumatic cataract and an intraocular metallic foreign body (IOFB) lodged in the superficial layers of the retina inferotemporal to the disc, causing an inferotemporal branch retinal artery occlusion. The case was managed by lensectomy with pars plana vitrectomy and IOFB removal followed by a second procedure of secondary IOL implantation. Final best-corrected visual acuity improved to 6/24. This case highlights an unusual sequelae following penetrating ocular trauma.

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CASO CLÍNICO: Paciente con amaurosis brusca debido a oclusión de arteria central de la retina (OACR), en el que se objetivó insuficiencia mitral y hemocultivos positivos para Streptococcus viridans. Con el estudio de ecografía transesofágica, se diagnosticó de endocarditis infecciosa subaguda sobre válvula nativa mitral que cursó sin fiebre y con la pérdida de visión como único síntoma. DISCUSIÓN: La OACR debida a endocarditis infecciosa es muy infrecuente, y hay escasos casos reportados en la literatura médica. La semiología y el estudio sistemático y exhaustivo de los pacientes con esta OACR, ayuda a descubrir enfermedades graves subyacentes. La endocarditis infecciosa tiene formas muy diversas de presentación y con frecuencia se requiere una alta sospecha clínica para llegar a su diagnóstico

CLINICAL CASE: A patient with acute amaurosis due central retinal artery occlusion (CRAO), who had mitral regurgitation and Streptococcus viridans positive blood cultures. Using transesophageal ultrasound, the patient was diagnosed with native valve infective endocarditis without fever, and with loss of vision as the only symptom. DISCUSSION: CRAO due to infective endocarditis is rare and there are few cases reported in the literature. Semiology and a systematic and comprehensive study of patients with this ophthalmological pathology helps uncover serious underlying medical conditions. Infective endocarditis has many different forms of presentation and a high clinical suspicion is often required to reach a diagnosis

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Postoperative visual loss is a rare but disastrous complication that has an estimated incidence of 0.01-1% after non-ocular surgery. We report a patient who underwent a prolonged spinal operation in the prone position and complained of blindness in one eye postoperatively. We consider the potential aetiological factors contributing to this unilateral postoperative visual loss and suggest strategies to reduce the incidence of this complication in spinal surgery.

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Relatamos o caso de um paciente com hematúria franca, sem causa evidente, que ao exame ocular apresentava comunicaçäo arteriovenosa retiniana no olho direito. Os autores discutem a associaçäo do envolvimento retiniano com lesöes semelhantes em outros órgäos

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Pudemos examinar paciente de 63, negro, do sexo masculino com macroaneurisma da artéria cílio-retiniana em OD. Ele relatava ser portador de hipertensäo arterial e tinha severo comprometimento da vascularizaçäo retiniana com cruzamentos arterio-venosos patológicos e arteríolas em fio de cobre. Desde que os macroaneurismas retinianos foram descritos em 1973 encontramos apenas 2 casos na literatura. Existem várias hipóteses para a raridade do macroaneurisma neste local. Possivelmente o acometimento da artéria cílio-retiniana seja devido a um comprometimento vascular severo generalizado com grave repercussäo na vascularizaçäo retiniana

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Blindness following elective cosmetic surgery can be a devastating complication, for the patient as well as the surgeon. A case of unilateral blindness secondary to central retinal artery occlusion following an open septorhinoplasty is presented. Possible causes of blindness following rhinoplasty and steps to prevent this complication are addressed.

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Four patients had central retinal artery occlusions after retrobulbar anesthesia with lidocaine HCl was administered before photocoagulation. One of these four had two separate episodes of closure. Only one had permanent visual loss, and none had evidence of retrobulbar hemorrhage. Each patient had a severe hematologic or vascular disorder. We think that direct trauma to the central retinal artery behind the globe, the pharmacologic or compressive effects of the injected solution, or both caused the occlusions in these patients.

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Four patients had central retinal artery occlusions after retrobulbar anaesthesia with lidocaine HCl was administered before photocoagulation. One of these four had two separate episodes of closure. Only one had permanent visual loss and none had evidence of retrobulbar hemorrhage. Each patient had a severe hematologic or vascular disorder. We think that direct trauma to the central retinal artery behind the globe, the pharmacologic or compressive effects of the injected solution,or both caused the occlusions in these patients. (AU)

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Cataract surgery in the eye of a 71 year-old male was complicated by an expulsive hemorrhage. The eye became blind and was removed 21 days later. Histopathological evaluation revealed facts of outstanding interest: rupture of the long posterior ciliary artery on the nasal side was the cause of the massive bleeding and cystoid macular edema with vertical infolding of the central cones was found in the totally detached and distorted retina.

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A 29-year-old man sustained a metallic (98% iron) foreign body in the optic nerve head, which resulted in a massive vitreous hemorrhage and a secondary branch retinal artery occlusion. An initial pars plana vitrectomy was successful in removing the vitreous hemorrhage, but numerous attempts with pars plana and intravitreal electromagnets failed to dislodge the foreign body. A second operation using a microscalpel and foreign body forceps with the bimanual pars plana technique was successful in removing the steel foreign body from the optic nerve-head.

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