Paracentral acute middle maculopathy as a finding in patients with severe vision loss following phacoemulsification cataract surgery: PAMM following cataract surgery
Authors:
Katarina Creese
Daini Ong
Sukhpal Singh Sandhu
David Ware
C Alex Harper
Salmaan H Al-Qureshi
Sanjeewa S Wickremasinghe
Abstract
Importance: Paracentral acute middle maculopathy (PAMM) diagnosed by spectral domain optical coherence tomography (SD-OCT) in patients with poor visual outcome post cataract surgery.
Background: Case series of severe vision loss due to PAMM after cataract surgery.
Design: Retrospective case series.
Participants: Cases from five surgical centres in Victoria, Australia.
Methods: Retrospective analysis of cases with unexplained ‘patch-off’ vision loss post cataract surgery. All patients in our cohort had PAMM and presumed diagnosis of central or transient retinal artery occlusion.
Main outcome measures: A review of the patient histories focusing on pre-operative ocular and systemic vascular risk factors, anaesthetic and operative factors.
Results: Ten cases were included. All patients had 6/72 Snellen visual acuity or worse noted on day one post surgery. Three patients had features of central retinal artery occlusion consisting of retinal pallor with a ‘cherry red’ macula but absent relative afferent pupillary defect. Seven had no features of retinal pallor or attenuation of retinal arterioles. On SD-OCT, all eyes had evident PAMM. Six patients had a history of cardiovascular disease or blood dyscrasia.
Conclusions and relevance: PAMM should be considered in patients with ‘patch off’ visual loss and absence of other fundal signs. We hypothesise that spasm or transient occlusion of central retinal artery leads to arterial hypoperfusion with subsequent ischaemia or infarction of the retina. Underlying arterial disease may have led to pre-existing hypoperfusion that may have been further compromised by raised intraocular pressure during the procedure itself or via raised orbital pressure from the anaesthesia.
References:
Transient retinal artery occlusion during phacoemulsification cataract surgery
Aug 2014
Imran H Yusuf
T. H. M. Fung
Martin Wasik
Chetan Kantibhai Patel
Effects of peribulbar anesthesia on ocular blood flow in patients undergoing cataract surgery
Jun 1999 AM J OPHTHALMOL
Oliver Findl
Susanne Dallinger
Rupert Menapace
Leopold Schmetterer
Subcutaneous Single Injection Digital Block with Epinephrine
Jan 2012
Motoki Sonohata
Satomi Nagamine
Kazumasa Maeda
Masaaki Mawatari
Adrenaline with lidocaine for digital nerve blocks
Jul 2013 COCHRANE DB SYST REV
Hemanshu Prabhakar
Santosh Rath
Mani Kalaivani
Safety of Epinephrine in Digital Nerve Blocks: A Literature Review
Aug 2015 J EMERG MED
Jonathan Ilicki
Spectrum of Retinal Vascular Diseases Associated With Paracentral Acute Middle Maculopathy
Apr 2015
Xuejing Chen
Ehsan Rahimy
Robert C. Sergott
David Sarraf
Adrenaline with lidocaine for digital nerve blocks
Mar 2015 COCHRANE DB SYST REV
Hemanshu Prabhakar
Santosh Rath
Mani Kalaivani
Neel Bhanderi
Retinal toxicity after intracameral use of a standard dose of cefuroxime during cataract surgery
Oct 2014 DOC OPHTHALMOL
Céline Faure
Daniel Perreira
Isabelle Audo
The Risk of Toxic Retinopathy in Patients on Long-term Hydroxychloroquine Therapy
Oct 2014
Ronald B. Melles
Michael F. Marmor
Paracentral acute middle maculopathy spectraldomain optical coherence tomography feature of deep capillary ischemia
Mar 2014 Curr Opin Ophthalmol
Ehsan Rahimy
David Sarraf
Hemorrhagic Retinal Infarction Due to Inadvertent Overdose of Cefuroxi me in Cases of Complicated Cataract Surgery: Retrospective Case Series
Nov 2013
Ciftci Suleyman
Leyla Ciftci
Umut Dag
Six-year incidence of endophthalmitis after cataract surgery: Swedish national study
Jan 2013
Emma Friling
Mats Lundström
Ulf Stenevi
Per Montan
Central retinal artery occlusion after phacoemulsification
Oct 2010
Brighu Narayan Swamy
Rohan Merani
Alex P Hunyor
Anaesthesia techniques for cataract surgery: A survey of delegates to the Congress of the International Council of Ophthalmology, 2002
Oct 2005 Clin Exp Ophthalmol
Robert Eichel FANZCA
Ivan Goldberg FRANZCO
Robert Eichel
Ivan Goldberg
Ocular toxicity after intracameral injection of very high doses of cefuroxime during cataract surgery
Feb 2011
Marie-Noelle Delyfer
Marie-Bénédicte Rougier
S. Leoni
Jean-François Korobelnik
Intraocular Pressure and Calculated Diastolic Ocular Perfusion Pressure during Three Simulated Steps of Phacoemulsification In Vivo
May 2009 Investig Ophthalmol Vis Sci
Yune Zhao
Xingyu Li
Aizhu Tao
Fan Lu
Retinal Toxicity Secondary to intraocular Gentamicin Injection
Aug 1986 OPHTHALMOLOGY
H. Richard McDonald
Howard Schatz
Arthur W. Allen
J. Dennis Snider
Prostaglandins and Cystoid Macular Edema
Sep 2002 SURV OPHTHALMOL
Kensaku Miyake
Nobuhiro Ibaraki
Transient central retinal artery occlusion after posterior sub-Tenon’s anesthesia
Oct 2003 J CATARACT REFR SURG
Robert Feibel
David L Guyton
Central retinal artery occlusion after peribulbar anesthesia
May 2004 J CATARACT REFR SURG
Albert Vinerovsky
Eitan Z Rath
Uri Rehany
Shimon Rumelt
ESCRS study of prophylaxis of postoperative endophthalmitis after cataract surgery: Preliminary report of principal results from a European multicenter study
Mar 2006 J CATARACT REFR SURG
Peter Barry
David Seal
G Gettinby
Crawford W Revie
Effects of the Local Anaesthetic Ropivacaine on Vascular Reactivity in the Mouse Perfused Mesenteric Arteries
Jun 2006 BASIC CLIN PHARMACOL
Clarisse F Timponi
Nilton E Oliveira
Roberia M P Arruda
Elisardo C Vasquez
Crystalline Retinopathies
Nov 2006 SURV OPHTHALMOL
Kimberly A Drenser
David Sarraf
Atul Jain
Kent W Small
