A temporary gas bubble holds the retina in position as laser or freezing treatment seals the retina to the eye wall. The fluid that created the retinal detachment is then drained through the existing retinal tear, thereby reattaching the retina. Vitrectomy surgery involves the use of microscopic cutting instruments to remove the vitreous gel and any scar tissue present inside the eye. The scleral buckle stays in place permanently and does not harm the eye. Laser or freezing therapy is then used to seal the retina back into place once it is reattached. The surgeon may also drain accumulated fluid behind the retina. Scleral Buckling is a surgical procedure in which a piece of soft silicone material is sewn against the outside wall of the eye, creating an indentation which closes the retinal defect that caused the detachment.
Surgery is out-patient, meaning no overnight stay, usually performed using local anesthesia. Depending upon the nature of the retinal detachment, the eye physician will determine the best repair methodology.
More than one technique may be used during a procedure. Although the cause of CRAO in these 4 cases remains unclear, and direct central retinal artery compression cannot be ruled out, injury to the central retinal artery or its branches may have caused the formation of vascular emboli and CRAO.The techniques used to repair a retinal detachment include scleral buckling, vitrectomy, or pneumatic retinopexy. In 4 out of the 17 previously reported cases ( Table 2), retrobulbar hemorrhage or optic nerve sheath hematoma were observed. Sharp needles were used in 4 of our 5 CRAO patients to deliver anesthetic, supporting the notion that direct injury to the ophthalmic artery or its collaterals can result in CRAO. Although injection agents and sites were different than those examined in this study, this phenomenon may still underlie CRAO development following retrobulbar anesthesia. We recently suggested retrograde embolic propagation through collateral ophthalmic artery vessels as a mechanism for CRAO development following cosmetic facial filler injection. documented that retrobulbar and peribulbar injection of a nesthetic agent causes vasoconstriction of the ophthalmic artery and a subsequent reduction in ocular blood flow. At the last follow-up visit, best-corrected visual acuity was no light perception in 2 eyes, light perception in 1 eye, and the ability to count fingers in 2 eyes. Mean follow-up duration was 1,139.4 ± 710.1 days (range, 4 to 1,807 days) and final visual outcome was poor in all patients. In the 3 patients who underwent intra-arterial thrombolysis, transfemoral cerebral angiography revealed ophthalmic artery stenosis in 1 case, internal carotid and ophthalmic artery stenosis in 1 case, and no steno-occlusive or remarkable lesions in 1 case. Patients were managed with observation (1 case), anterior chamber paracentesis (1 case), or intra-arterial thrombolysis (3 cases).
There were 2 (40%) patients who underwent cataract surgery (phacoemulsification and posterior chamber intraocular lens implantation) and 3 (60%) patients who underwent vitrectomy (1 patient with air). All patients presented with acute visual disturbance noted when they removed their eye patches 1 day after uneventful intraocular surgery. All patients had one or more vascular risk factor, including hypertension, diabetes, prior cerebral infarction, myocardial infarction, and/or carotid artery stenosis. The mean patient age was 67.0 ± 8.2 years (range, 53 to 72 years). A total of 3 (60%) patients had isolated CRAO and 2 (40%) patients had CRAO with ophthalmic artery occlusion. Patient demographics and clinical characteristics are summarized in Table 1. A total of 5 patients (2 men and 3 women ) met all inclusion criteria ( Figs.
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