Mechanical displacement of retinal arterial embolus during vitrectomy: A simplified surgical approach and literature review.
Marco Anastasi, Erika Bonacci, Elena Veronica Perozzo et al.
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Case in brief
A 50-year-old man with type 2 diabetes and hypertension developed sudden left-eye visual loss with an inferior field defect from branch retinal artery occlusion. Digital massage, intraocular-pressure-lowering therapy, and anterior chamber paracentesis were unsuccessful. Pars plana vitrectomy was performed 22 hours after onset, with low intraoperative pressure and gentle distal displacement and fragmentation of the embolus using a diamond-dusted scraper. Retinal perfusion returned during surgery. Visual acuity improved from counting fingers to 6/6 by one month and remained stable at six months; imaging showed resolution of inner retinal edema and complete reperfusion without recurrence.
What made this case unusual
Despite intervention 22 hours after symptom onset—beyond the conventional 4–6-hour therapeutic window—mechanical embolus displacement during vitrectomy was followed by restored perfusion and substantial visual recovery.
Diagnostic / clinical pearl
In selected branch retinal artery occlusion cases, persistent visual loss with an identifiable embolus may prompt consideration of targeted mechanical displacement during vitrectomy, even when presentation is beyond the conventional treatment window.
Why it matters
The report and focused review highlight uncertainty about surgical timing, technique, and patient selection; prospective trials are needed to define these.