Unexpected Poor Vision within 24 h of Uneventful Phacoemulsification Surgery-A Review

Abstract

Review on day one post uneventful phacoemulsification surgery is no longer standard practice due to the infrequency of complications when using modern cataract removal techniques. Clinicians are therefore likely to be unfamiliar with the potential causes of reduced vision when presented with a patient in the immediate postoperative period. The purpose of this review is to discuss the various differential causes of early visual loss, for the benefit of clinicians presented with similar patients in emergency care, with the use of an illustrative clinical case of paracentral acute middle maculopathy (PAMM), which recently presented to the authors. A thorough literature search on Google Scholar was conducted, and only causes of visual loss that would manifest within 24 h postoperatively were included. Complications are inherently rare in this period; however, various optical, anterior segment, lens-related and posterior segment causes have been identified and discussed. Front-line clinicians should be aware of these differentials with different mechanisms. PAMM remains to be the only cause of unexpected visual loss within this time frame that may have no abnormal findings on clinical examination.

Keywords: cataract; complications of cataract surgery; paracentral acute middle maculopathy (PAMM).

Figure 1

Preoperative OCT images taken on 7 June 2021. There is normal enhancement of the layers of the neural retina. Macular thickness is within the normal range.

Figure 2

Day one postoperative OCT cross section showing total loss of the negatively enhancing inner nuclear layer, replaced by a highly reflective band marked by a red arrow.

Figure 3

Sequential visual field assessment. The results were variable; however, they demonstrate a persistent but varying in shape scotoma on 10–2 central field perimetry.

Figure 4

OCT imaging (26 January 2022) demonstrating persistent loss of the inner nuclear layer, with marked macular thinning but preserved circumpapillary retinal nerve fibre layer thickness.