Título

RETINAL ISCHEMIA SECONDARY TO OCCLUSION OF THE CENTRAL RETINAL ARTERY AFTER ANESTHESIA INFILTRATION OF BLEPHAROPLASTY SURGERY

Introdução / Purpose

The authors present a case of retinal ischemia secondary to central retinal artery occlusion after anesthesia infiltration of transconjunctival blepharoplasty surgery in a male patient, with complaint of sudden low visual acuity in the immediate postoperative period.

Material e Método / Methods

OBSERVATION

Resultados / Results

E.S.L., male, 56 years old, natural and resident of São Paulo, with complaint of sudden unilateral visual acuity after elective surgery 7 days of transconjunctival blepharoplasty using infiltrative anesthetic Xylocaine 2% with adrenaline 20 cc diluted in saline 40 cc, in the exam presented visual acuity of 20/200, 20/20 and The indirect ophthalmoscopy examination and fundus evaluation, papilla with blurred edges hyperemic, with diffuse retinal edema in the posterior pole with cotton exudates, presence of deep and preretinal hemorrhages between the temporal arches. Increased diffuse vascular tortuosity with arteriolar narrowing and venous engorgement in the right eye.

Discussão e Conclusões / Discussion

in the acute vasocclusive occlusion of the central retinal artery, the central retinal artery reopens or recanalizes and the retinal edema clears; however, the effect on visual acuity is usually permanent because the inner retina has been infarcted. In one study, 66% of eyes had final visual acuity worse than 20/400, and 18% of eyes had 20/40 or better. Most cases of 20/40 or better visual acuity occur in the presence of a patent cilioretinal artery. Vaso-occlusive loss of vision to the level of no light perception is usually caused by choroidal vascular insufficiency from partial or complete ophthalmic artery occlusion or occlusions of the ciliaryarteries in conjunction with occlusion of the central retinal artery. Studies in nonhuman primates have suggested that irreversible damage to the sensory retina occurs after 90 minutes of complete central retinal artery occlusion. Nevertheless, clinical return of vision can occur in some instances even if the obstruction has persisted for many hours.

Palavras Chave

RETINAL ISCHEMIA, central retinal artery occlusion, CRAO, ANESTHESIA INFILTRATION