Cookies on this website
We use cookies to ensure that we give you the best experience on our website. If you click 'Continue' we'll assume that you are happy to receive all cookies and you won't see this message again. Click 'Find out more' for information on how to change your cookie settings.

PURPOSE: Transient retinal artery occlusion (TRAO) is a potentially underdiagnosed cause of immediate 'pad off' visual loss following phacoemulsification cataract surgery under sub-Tenon's anaesthesia. METHODS: We describe a series of three patients presenting with enigmatic 'pad off' visual loss following phacoemulsification surgery, each diagnosed with TRAO. We describe the variable clinical presentation, illustrate the value of optical coherence tomography (OCT) imaging in establishing the diagnosis, and present the final visual outcomes. RESULTS: Clinical findings alone may be subtle and inadequate in localising the pathology in patients with TRAO. Cross-comparison of superior and inferior macula OCT profiles in branch-pattern arterial occlusion-and between healthy and affected eyes in central-pattern arteriolar occlusion-is critical in clinching the diagnosis. The typical evolution of OCT appearance is acute-phase inner retinal thickening/oedema and hyperreflectivity followed by progressive, late-phase inner retinal atrophy. Visual acuity may recover but central scotomas, and defects in colour perception may persist. CONCLUSION: The diagnosis of TRAO is challenging; delayed presentation may resolve fundal and retinal angiographic abnormalities. OCT may be the only imaging modality that can provide objective evidence of TRAO. Meticulous comparison/segmentation of OCT images is therefore mandatory in patients presenting with acute post-operative visual loss to exclude TRAO.

Original publication

DOI

10.1038/eye.2014.190

Type

Journal article

Journal

Eye (Lond)

Publication Date

11/2014

Volume

28

Pages

1375 - 1379

Keywords

Aged, Fluorescein Angiography, Humans, Male, Middle Aged, Phacoemulsification, Retinal Artery Occlusion, Scotoma, Tomography, Optical Coherence, Vision, Low, Visual Acuity, Visual Field Tests, Visual Fields