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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


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.


University and Polytechnic Hospital la Fe, Valencia, Spain


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.


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.


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.

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