Retinal Pigment Epithelial Tear Following Uneventful Cataract Surgery Under Local Anesthesia.

To report an unusual case of Retinal Pigment epithelium (RPE) tear following cataract under ophthalmic local anesthesia, in the absence of any known risk factors for RPE tear. To date, there has been no documented case of RPE tear after local anaesthesia in the literature. 

Tertiary medical center, Riyadh, Saudi Arabia

A 65-year-old female presented with distortion of vision in her left eye. She is one week status post uneventful phacoemulsification under local ophthalmic anesthesia. Preoperatively, her eye exam was unremarkable except for a cataract in the left eye. 

On examination, her visual acuity is 20/50 in the operated eye. Dilated fundus examination revealed a hyperpigmented retracted RPE line with an area of depigmentation consistent with bare choroid. Optical Coherence Tomography (OCT) revealed subretinal fluid and an RPE tear without evidence of fibrovascular Pigment epithelial defect (PED) or Choroidal neovascular membrane (CNVM). The patient was managed conservatively, and her visual acuity improved to 20/25, with resolution of subretinal fluid and partial healing of the RPE tear.

RPE tears may occur following uneventful cataract surgery under ophthalmic local anesthesia, even in the absence of known predisposing factors such as Age Macular Degeneration (AMD) or anti-vascular endothelial growth factor (Anti-VEGF) therapy. This case highlights the importance of considering RPE tears as a rare but potential complication of local ophthalmic anesthesia.