A case of branch retinal artery occlusion postcataract surgery in an antiphospholipid syndrome patient

Abstract

A 46-year-old female with preoperative vision 6/18 N18 (LogMar 0.5) in re and posterior subcapsular cataract underwent an uneventful phacoemulsification surgery under a peribulbar block. On the postoperative day 2, she complained of no visual gain in the operated eye. The reported vision was counting fingers close to the face. Through multimodal imaging (MMI), a diagnosis of branched retinal artery occlusion (BRAO) was made. A detailed consultation and history taking with the patient revealed a concealed history of four miscarriages in the past. A detailed systemic blood workup revealed antiphospholipid antibody (APLA) positive. BRAO postuneventful cataract surgery is a devasting outcome for the surgeon and patient undergoing surgery. The report focuses on the importance of taking detailed past medical history and usage of MMI early to rule out and diagnose unexpected scenarios. We suggest BRAO in our patient was a result of emboli formation, which is a common element in APLA-positive patients.

Keywords: Antiphospholipid syndrome; branched retinal artery occlusion; cataract surgery.

Figure 1

Color fundus photo showing the area of retinal whitening involving the fovea (arrow) and extending inferiorly

Figure 2

SS-OCTA 6 mm × 6 mm deep slab shows decreased perfusion and disorganization of vascular plexus around and inferior to the fovea. SS-OCTA: Swept-source optical coherence tomography angiography

Figure 3

(a) HD-51 scan shows hyperreflective and thickened inner retina with alteration of the foveal contour (yellow arrow), (b) Significant reduction in innerretinal hyperreflectivity( white arrow) and thickness noted in 4 weeks