A 45-year-old woman presented with sudden, painless vision loss in her left eye of 19 hours’ duration. Best-corrected visual acuity was 20/2000. Fundus examination revealed whitening along the superior temporal and inferior nasal arcades ( Figure A ). Preoperative fluoresceinangiography demonstrated flow voids in the corresponding vascular territories, confirming nonperfusion ( Figure B ).
Preoperative fundus photograph reveals retinal whitening along the superior temporal and inferior nasal arcades.
Preoperative fluorescein angiography demonstrates flow voids in the corresponding vascular territories, confirming nonperfusion.
A 27-gauge 3-port vitrectomy was performed at 22 hours (DORC, Zuidland, Netherlands) (video 1). Intraoperatively, a white embolus was found completely obstructing the entire lumen at a branch artery crossing on the optic disc, with no observable distal blood flow ( Figure C ). The vitreous cutter was used to gently massage the vessel. After the massage, the large embolus was fragmented into multiple small pieces, which were then carried by the blood flow through the superior branch arteries and displaced distally ( Figure D ). At the end of the surgery, no residual embolus was visible at the original obstruction site, and the vessel was fully reperfused. Postoperative day 1 fundus examination revealed complete reperfusion of the retinal arterial territories ( Figure E ). Postoperative day 1 fluorescein angiography confirmed reperfusion of the superior and inferior arterial territories ( Figure F ). The patient reported immediate relief from the visual field defect on the first postoperative day. Visual acuity had improved to 20/200 by postoperative day 7.
