|Year : 2019 | Volume
| Issue : 3 | Page : 392-394
A case of posterior ciliary artery occlusion following pneumatic reposition of the Descemet membrane
Alok C Sen, Gaurav M Kohli, Ashish Mitra, Pawan P Malhotra
Department of Vitreo-Retina, Sadguru Netra Chikitsalaya, Chitrakoot, Madhya Pradesh, India
|Date of Submission||13-Aug-2018|
|Date of Acceptance||26-Nov-2018|
|Date of Web Publication||18-Feb-2019|
Dr. Alok C Sen
Department of Vitreo-Retina, Sadguru Netra Chikitsalaya, Chitrakoot, Madhya Pradesh - 210 204
Source of Support: None, Conflict of Interest: None
Keywords: Air descemetopexy, descemetopexy, descemetopexy complications, posterior ciliary artery occlusion
|How to cite this article:|
Sen AC, Kohli GM, Mitra A, Malhotra PP. A case of posterior ciliary artery occlusion following pneumatic reposition of the Descemet membrane. Indian J Ophthalmol 2019;67:392-4
|How to cite this URL:|
Sen AC, Kohli GM, Mitra A, Malhotra PP. A case of posterior ciliary artery occlusion following pneumatic reposition of the Descemet membrane. Indian J Ophthalmol [serial online] 2019 [cited 2019 May 24];67:392-4. Available from: http://www.ijo.in/text.asp?2019/67/3/392/252405
| Case Report|| |
A 60-year-old, non-diabetic, non-hypertensive female presented to us a day after undergoing pneumatic air descemetopexy for postoperative planar inferior Descemet membrane (DM) detachment [Figure 1] in the left eye (LE). DM reposition was performed using air under peribulbar anesthesia. The intraocular pressure (IOP) measured in the LE at 12 h was 18 mmHg, with a blood pressure of 110/70 measured preoperatively.
|Figure 1: Anterior segment optical coherence tomography shows presence of planar Descemet membrane detachment|
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About 24 h post-descemetopexy, the vision dropped to light perception (PL). Anterior segment was unremarkable with residual air bubble. Fundus examination showed a tongue-shaped area of patchy retinal whitening involving peripapillary and macular territory [Figure 2]. The fundus fluorescein angiography (FFA) showed a normal arm-to-retina time with areas of segmental hyperfluorescence having fuzzy margins, corresponding to the areas of retinal whitening [Figure 3]a.
|Figure 2: A tongue-shaped area of retinal whitening was present around the disc* and involving the macula** following decemetopexy, this corresponded to the watershed zone|
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|Figure 3: (a) Areas of segmental hyperfluorescence having fuzzy margins, corresponding to the areas of retinal whitening*. (b) Optical coherence tomography revealed increased reflectivity of the outer-retinal layers. A hyperreflective line separated the inner layers from the outer layers*, suggestive of photoreceptor swelling and ischemic injury to outer-retinal layers|
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The optical coherence tomography (OCT) revealed an increased reflectivity of the outer retinal layers [the retinal pigment epithelium (RPE) and the photoreceptor layer] along with a thickened outer plexiform layer [Figure 3]b. A hyperreflective line separated the inner layers from the outer layers, suggestive of photoreceptor swelling and ischemic injury to outer-retinal layers. The inner-retinal layers were well segmented and unremarkable.
Based on the clinical picture, FFA, and OCT findings a diagnosis of LE posterior ciliary artery occlusion (PCAO) was made. FFA repeated at 1 week showed transmitted hyperfluorescence. OCT showed outer-retinal thinning with loss of photoreceptor layer, accompanied with RPE hyperreflectivity [Figure 4].
|Figure 4: (a) An area of retinal pigment epithelium (RPE) atrophy developed subsequently in the zone of previous retinal whitening*. (b) Optical coherence tomography showed outer-retinal thinning with loss of photoreceptor layer, accompanied with RPE hyperreflectivity*|
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| Discussion|| |
PCAO is a rare vascular accident, often caused by embolization from the internal carotid artery or by external compression., The choroidal vascular bed can maintain a constant perfusion pressure despite the change in IOP and blood pressure. Since the autoregulatory facility of the choroid compensates better for variation in mean perfusion pressure than for IOP fluctuations, a transient rise in IOP following air descemetopexy can overwhelm an already compromised choroidal flow.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
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[Figure 1], [Figure 2], [Figure 3], [Figure 4]