백내장수술 전 구후마취 직후 발생한 망막중심동맥과 중심정맥의 폐쇄 1예

Combined Central Retinal Vein and Artery Occlusion After Retrobulbar Anesthesia: A Case Report

Purpose: To report central retinal vein and artery occlusion after retrobulbar anesthesia for a cataract operation. Case summary: A 65-year-old woman was transferred to our facility 4 days after she had undergone cataract extraction with IOL implantation. She could count fingers and had a relative afferent papillary defect in her left eye. As seen upon fundus examination, dot-shaped, circular-shaped irregular, and partially linear-shaped retinal hemorrhages were evident. Fluorescein angiography revealed that branch arteries around the nasal and temporal areas were not filled, and that the filling of veins was delayed. After two weeks, the patient was only able to recognize hand motion, and her intraocular pressure was 10 mmHg. According to a fundus examination, the size and quantity of retinal hemorrhages increased, and a pale, macular edema was observed. Following fluorescein angiography, the filling defect of branch vessels on the nasal and temporal areas was still evident, and the blocked fluorescence of capillaries on the fundus was prominent. After two months, she could still only recognize hand motion, and her intraocular pressure had increased to 35 mmHg; we therefore diagnosed a neovascular glaucoma. Conclusions: A patient experienced a serious central retinal vessel occlusion after retrobulbar anesthesia for cataract extraction. Retrobulbar injections should therefore be administered with great caution to prevent this outcome. J Korean Ophthalmol Soc 49(6):1013-1017, 2008