Progressive Bilateral Visual Acuity Decline After Uncomplicated Cataract Surgery: Neuro-Ophthalmological Presentation Of Cerebral Infarction
Published 2026 - 44th Congress of the ESCRS
Reference: POCAT116 | Type: Case Report | DOI: 10.82333/f24h-f151
Authors: Dr Ema Trajkova 1 , Prof. Dr Biljana Kostovska* 2 , Dr Martina Sofronijevikj 3 , Dr Era Tateshi 4 , Dr Sumeja Ebibi Kasami 5 , Dr Ljuben Angelovski 1 , Dr Viktorija Shamovska - Petreska 6 , Dr Sara Blazhevska 7
1Sistina Ophthalmology, Promedika,Skopje ,North Macedonia, 2Sistina Ophthalmology, Promedika,Skopje ,North Macedonia;Faculty of medicine University Goce Delcev,Stip,North Macedonia, 3Sistina Ophthalmology,Skopje ,North Macedonia, 4City General hospital 8th September ,Skopje ,North Macedonia, 5Sistina Ophthalmology, Promedika,Kumanovo,North Macedonia, 6General Hospital with Extended activity Borka Taleski,Prilep,North Macedonia, 7University Eye Hospital Svjetlost,Zagreb,Croatia
Purpose
Cataract surgery with phacoemulsification and intraocular lens implantation represents
one of the most successful surgical procedures in ophthalmology, with highly
predictable functional outcomes. In the absence of structural abnormalities, the
possibility of a central neurological etiology must be considered.
Setting
A 51-year-old female presented for examination with decreased distance vision and was
diagnosed with bilateral early-stage cataract. Preoperative best-corrected visual acuity
(BCVA) was 18/20 in both eyes. Uncomplicated bilateral phacoemulsification with
implantation of multifocal intraocular lenses was performed. In the early postoperative
period, visual acuity of 20/20 was achieved bilaterally, with normal findings in both the
anterior and posterior segments.
Report of case
Two months after surgery, the patient began to report gradual visual deterioration
accompanied by subjective visual field changes. Visual acuity progressively declined to
8/20 bilaterally. Slit-lamp examination revealed clear corneas, well-centered intraocular
lenses, and absence of posterior capsule fibrosis. Fundus examination was
unremarkable. Optical coherence tomography of the macula and optic nerve showed no
morphological abnormalities. Automated perimetry demonstrated homonymous
superior quadrantanopia.
Due to the discrepancy between significant functional impairment and normal structural
ocular findings, urgent neuroradiological evaluation was indicated. Magnetic resonance
imaging with contrast revealed post-infarction sequelae localized in the right brainstem.
Neurological assessment confirmed cerebral infarction, and appropriate
antihypertensive and antithrombotic therapy was initiated
Conclusion/Take home message
This case highlights the need for timely neuro-ophthalmological assessment in patients
presenting with unexplained visual acuity decline following anatomically successful
cataract surgery. Normal OCT findings and absence of ocular pathology should raise
suspicion of a central etiology and prompt a multidisciplinary diagnostic and therapeutic
approach. Subjective symptoms should be carefully evaluated and openly discussed with
patients.